What Medicare Part C Covers - Medicare Consumer - Medicare Consumer

What Medicare Part C Covers

Medicare Part C is also known as Medicare Advantage. These are health plans that are actually offered by private insurance companies that contract with Medicare in order to offer Medicare Part A and Part B benefits, as well as some additional coverage.

It is required that all Medicare Advantage plans cover all of the services that Medicare Part A and B (Original Medicare) provide – other than hospice coverage. This is because Original Medicare will cover hospice care, even if an individual is enrolled in a Medicare Advantage plan. In addition, all Medicare Advantage plans will also cover both emergency and urgent care services.

Medicare Advantage plans can also offer additional coverage as well, such as dental, vision, and / or wellness benefits. Many of these plans will include Medicare Part D prescription drug coverage as well.


Types of Medicare Advantage Plans

There are several different types of Medicare Advantage plans. These include the following:

  • Health Maintenance Organizations (HMO) – With an HMO plan, participants are only allowed to use health care providers that are listed in a particular network. In most cases, enrollees must also get a referral prior to seeing a specialist.
  • Preferred Provider Organizations (PPO) – Enrollees who are in a PPO plan are allowed to use providers and specialists of their choosing – however, if these providers are outside of the plan’s network, then the cost will be higher.
  • Private Fee-for-Service (PFFS) – In the PFFS option, a participant can go to any doctor or specialist that they choose. However, it will be required that the individual accept the required fees, terms, and conditions.
  • Special Needs Plans (SNP) – Special Needs Plans limit their membership to certain groups, such as those who have specific types of chronic health issues and live in institutions like nursing homes, or those who require home health care. These plans will also typically require that enrollees receive their care and services from providers that are included within a particular network.

Most Medicare Advantage HMO, PPO, and PFFS plans will offer a participant full coverage if care is obtained from a provider that is listed in the plan’s network. Many of these plans will also provide at least some amount of services for the participant if he or she is traveling.


How Much Does Medicare Part C Cost?

In addition to your Medicare Part B premium – which in 2015, is $104.90 per month for most people – there is typically an additional premium that is charged for being enrolled in a Medicare Advantage plan. The amount that you pay will depend upon the plan that you choose and the benefits that are covered.

Should you require a service that your Medicare Advantage plan says is not considered to be medically necessary, then you may be required to pay all of the costs for that service. You do, however, have the right to appeal that decision.

Although some Medicare Part C programs will require enrollees to obtain a referral prior to seeing a specialist, the premiums and / or cost of services may still be lower in a Medicare Advantage plan than they are in Original Medicare.

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