Medicare Part C

Medicare Part C is a health insurance cover facilitated by the government of the United States of America. Medicare is basically a social insurance. Part C of Medicare covers both Part A and Part B options. Medicare Part A is Hospital Insurance and Medicare Part B is Medical Insurance, therefore, Medicare Part C includes both Hospital and Medical Insurance covers. Medicare Part C is also renowned as Medicare Advantage Plan and includes plans such as Preferred Provider Organization [PPO], Health Maintenance Organization [HMO], etc.

To avail Medicare Part C
Visit the official website of Medicare, read the information, understand the concepts and join the plan by completing the application form
-Online
-Over phone
-Check-in-desks.

Medicare Part C Plans

Health Maintenance Organization (HMO) Plans – can consult doctors or specialists within the HMO and generally requires references.

Preferred Provider Organization (PPO) Plans - can consult doctors or specialists of your choice and reference not required. Additional cost for doctors outside the PPO network.

Private Fee-for-Service (PFFS) Plans – can consult any doctor who accepts the terms and conditions of PFFS. Reference not required.

Special Needs Plans (SNP) – for clients with certain chronic diseases or for those who require special medical care.

HMO Point of Service (HMOPOS) Plans— can find extra services outside the network for an added cost.

Medical Savings Account (MSA) Plans – includes:
Plan which allows you to use the cover only after the “high deductable” is deducted from your bank account.
Plan where Medicare deposits the cost in advance in your bank account for medical cover for the year.

Cost of Medicare Part C

The “out-of-pocket cost” for Medicare Part C is decided taking into account:

  • If the premium for the plan is monthly.
  • If the plan includes any Part B premium payment.
  • If there is any type of deductable.
  • If you plan to utilize the network providers option.
  • If you opt for additional facility with extra cost.
  • If there is cost of copayments or coinsurance.
  • The category and frequency of Medicare utilization.
  • The credit limit for the year.

Medicare Part C covers…

Medicare Part C covers any nature of critical or trauma care and gives the option to avail dental, hearing, vision, etc, treatments for an extra cost. Excluding hospice care, Medicare Part C includes all the items under Original Medicare Plan.

Additional facts regarding Medicare Part C

  • Except for End-Stage Renal Disease, any pre existing condition can be covered under Medicare Part C.
  • Medicare rights and protections [right to appeal] are not affected by being under Medicare Part C Plan.
  • Part C generally includes prescription drug coverage (Part D) too.
  • Even while travelling in a non-coverage area, Medicare Part C still covers medical emergencies.
  • When you decide to cease Medicare Part C plan, you need to enroll afresh for the Original Medicare Plan.
  • Plans may change every year.
  • Plans may differ for different geographical regions.
  • Each plan may be open only during a certain time of the year.