Medicare Part C

When it comes to applying for Medicare or finding out what benefits are available to you, the options can be overwhelming. There are many factors at play – where you live, if you or a spouse are working and have coverage provided by work, and what plan/s your doctors accept.

For most users, Medicare comes in four parts. Part A covers hospital stays, skilled nursing facilities, and, in some situations, hospice care, and in-home care. Part B covers most doctor visits, outpatient therapies, urgent care visits, and durable medical equipment. Part D is the prescription drug plan.

Part C Benefits

Also known as Medicare Advantage Plans, Medicare Part C coverage provides users with all services covered by Original Medicare (Parts A and B) and often include extra benefits such as dental, vision, and more. Medicare Part C bundles Part A and Part B and usually Part D into one plan. Private insurance plans can offer Part C if they are approved to do so by Medicare.

In order to acquire Part C, there are a few requirements, including:

  • You must live in an area that offers Part C plans. This is determined by which county you live in.
  • You must be currently enrolled in Parts A and B.
  • You must not currently have End-Stage Renal Disease (ESRD). However, if a patient develops ESRD after enrolling in Part C, they will not be dropped from the health plan. If this is the case with you or a loved one, talk to your Medicare insurance agent for other options available that might be better suited for that situation.

If you are able to enroll in Medicare Part C, there are still some steps to consider before joining a Medicare Advantage Plan. Although Part C encompasses the other two parts, users must continue to pay their Medicare Part B premium.

Your care provider will bill the Medicare Advantage Plan in place of Medicare. Medicare Advantage is your primary insurance. In most cases, the provider must be “in-network” for their services to be covered at all or to the fullest extent.

Plan premiums and your cost shares will vary by carrier and location. Medicare plans may change from year to year. Pans are renewable as long as you’ve paid your premiums and the plan is still available in your area.

Common Types of Medicare Advantage Plans

HMO (Health Maintenance Organizations) – Beneficiaries must go to hospitals and doctors that are part of the HMO network in order to have coverage (unless it is an emergency). A referral to see a specialist is usually required for an HMO.

PPO (Preferred Provider Organizations) – Allows the member to use out of network providers, although there is usually a higher cost associated with using out of network services. Referrals are not necessary, but prior authorization is required for some procedures.

PFFS (Private Fee For Service) – PFFS can offer full or partial networks of providers or may not use a network of providers at all. No matter what kind of network, its enrollees can see any provider available to accept payment from Medicare and agree to accept the plan’s terms and conditions of payment.

A doctor can choose to accept a PFFS plan on a case by case basis. This is also the one type of advantage plan you can purchase a stand-alone Part D Medicare Prescription drug coverage separately if a drug plan is not included.

SNP (Special Needs Plans) – Usually an HMO plan, except it’s limited to certain groups of beneficiaries that suffer from chronic or lasting disabilities conditions, eligible for Medicaid, or those living in care institutions.

Medicare supplements have higher monthly premiums, and lower cost-sharing and copays, while Medicare Advantage Plans are more “pay as you go.” They have much lower premiums, but you will pay for copays, coinsurance, or pay out of pocket costs, if necessary, every time you use it.

It’s a lot to consider, especially during your golden years. VibrantUSA is here to help – since 2003, we’ve been specializing in Medicare health insurance. During this time, we’ve been able to guide our clients through Medicare and its many choices and changes.

Work With The Medicare Program Experts

VibrantUSA is an independent medical insurance agency specializing in Medicare Insurance. We represent the majority of Medicare insurance plans available in Washington and Oregon. We assist our clients with selecting plans, purchasing plans, claims, questions/concerns, and provide up-to-date information on Medicare insurance.

We are an unbiased resource dedicated to finding the best plan for each client. We work with several insurance companies, have access to more than 50 different plans, and have the experience to get the right Medicare coverage for you. There is also no fee for our service – contact us today to see how we can help.

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