What Is Medicare Part C?
Having good healthcare coverage can be a make-or-break asset if an unexpected health crisis arises. As we get older, quality of life often depends on having reliable healthcare coverage that fits within our budget. The Medicare system provides a number of options to help meet those needs. Medicare Part C is an optional plan that can help pay some of the additional costs not covered under Parts A and B.
Identification
Medicare Part C, also known as Medicare Advantage Plan, is an add on to Medicare Part A and Medicare Part B coverages. While Part A covers hospital costs, and Part B covers medical expenses, Part C takes care of the co-pays and deductibles required under the other two plans. In addition, there are more options to choose from in terms of the type of coverage you have. To be eligible, you must be enrolled in Medicare Parts A and B
Features
The main difference between traditional Medicare (A and B) coverage and Medicare Advantage Plans is participants are required to work with a select group of doctors and facilities that are listed within a network. Traditional plans don't have this requirement. Extra benefits like prescription drugs, vision and dental coverages are also available under Part C.
Medicare Advantage plans are sold through private insurance companies, and may, or may not be available in certain areas depending on the population needs. As such, companies can charge different amounts for plan coverages so you might want to do some area price comparisons before deciding. Coverage under Part C is required to cover all the benefits under the traditional plans. There's a monthly premium payment required, which is in addition to the Plan B premium payment requirement.
Types
There are four Medicare Part C plan options available, all of which work in conjunction with a managed care network. The most popular option is the Health Maintenance Organizations(HMO), partly because they're the least expensive. Only doctors who work within the network are covered, and any referrals for a specialist must come from your primary care physician. The second plan is the Provider-Sponsored Organization (PSO). These are made up of facilities that provide medical care and insurance coverage. Everything is taken care of by the PSO facility, so there's no third party insurance entity involved. Only doctors who work within the organization are covered under this option.
The Point-Of-Service (POS) option allows you your choice of doctors and specialists, however Part C pays less towards services from doctors who are not a part of the network. The final option-Preferred Provider Organizations (PPO)-offers the same benefits as Point-of-Service. The difference between the two is Preferred Provider Organizations are typically available in rural areas, while Point-of Service providers are located in urban areas.
Function
Your individual healthcare needs will determine which type of Plan C coverage is best for you. Since Part C picks up where traditional coverage leaves off, only those services covered under Medicare will be covered under Part C. If you currently have a Medigap plan in place, then you probably don't need a Medicare Advantage Plan as the coverages are mostly the same.
Under some plans non-medical services like custodial care within a nursing facility, or at home, are covered. In the case of plans which include vision, dental and prescription costs, your premiums will most likely be higher. And while Medicare Advantage does cover most of the copay and premiums costs under Part A and B, there are co-pays, and sometimes deductibles required under an Advantage Plan.
Considerations
While Medicare Advantage Plans can potentially reduce your out-of-pocket costs, there are a couple things to keep in mind when deciding on what type of coverage you need. Plan availability will depend on what companies in your area offer Part C coverage. Also, the companies that do offer it have the option of pulling out of your area at any time. Oftentimes this will happen when there's not a high demand for services in a particular area. When this happens, participants are left to find alternative coverage on their own.
Tags: Medicare Part, Medicare Advantage, covered under, under Part, Advantage Plan
