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Medicare Part C – Medicare Advantage Plans Explained

Medicare Part C, sometimes referred to as Medicare Advantage, is a health plan option that is approved by Medicare and run by private companies. Medicare Part C is part of the Medicare Program.

When you join Medicare Part C, you are still in Medicare. It is just an alternative way of receiving your Medicare Part A and Part B benefits. Some of the Part C plans require referrals to see specialists. In many cases, the premiums or the costs of services (co-pays) can be lower in a Medicare Advantage Plan than they are in the Original Medicare (Medicare Part A and Part B).

Medicare Part C Plans provide all of your Part A hospital and Part B medical coverage and must cover medically necessary services. Medicare Advantage also must cover emergency and urgent care.

These plans generally also offer extra benefits, too, and many may include Part D drug coverage. In addition, these plans often have networks that are similar to HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plans. This means that you may have to see doctors who belong to a network or go to certain hospitals in order to get covered services.

In many cases, your costs for services through Medicare Part C plans can be lower than in the Original Medicare Plans. Some plans will coordinate your care, using networks and referrals. This can help manage your overall care and can also result in savings to you.

Medicare Part C plans must follow rules that are set by Medicare. However, each of these plans can charge different out-of-pocket costs, and they may have different rules for how you get services.

You usually pay one monthly premium to your Medicare Part C plan, in addition to your Medicare Part B premium. With Medicare Part C, Medicare pays an amount of money for your care every month to these private health plans, whether or not you use the services.

Medicare Part C plans also include options that provide specialized care for people who need a lot of health services. Even if you are out of the service area of the plan, you are still covered for emergency or urgently needed care.

Medicare Part C plans include:

  • Preferred Provider Organization (PPO) Plans
  • Health Maintenance Organization (HMO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans, and
  • Medical Savings Account (MSA) Plans

Your Medicare Advantage premiums will typically depend upon various factors such as whether the plan charges a monthly premium in addition to your Medicare Part B premium; whether the Part C plan has a yearly deductible; and the type of health care services you need and how often you receive them. It is important to note that if your Medicare Part C plan stops participating in Medicare, then you will need to join another plan or return to the Original Medicare.

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