Everything About How Medicare Part C Or Medicare Advantage Works

Medicare Advantage Plans, or often called Medicare Part C are offered by private companies. These are private plans run through Medicare. Further, by law, they must equivalent to regular Part A and Part B coverage. When one joins a Medicare Advantage Plan, they can still have Medicare.

Medicare Part C and how does Medicare Advantage Work

There are different variations among Part C Medicare. For instance, any given plan may cover less of one thing and more of another. It is a bit confusing but we will guide you on how does Medicare advantage work.


A Review On Medicare Part A, B, C, D

Before dwelling on Medicare Part C, it is important to know the different Medicare parts. These different parts cover distinguished services.

Original Medicare

This is the original plan the federal government directly administers. This is how most seniors get their Medicare. Also, Original Medicare covers 80% of Medical costs. Moreover, it has two parts: Part A Medicare (Hospital Insurance) and Part B Medicare (Medical Insurance).

Part A Medicare

Part A is also known as Hospital Insurance. Mostly, it covers hospital care, skilled nursing facility. Also, it covers hospice care and home health. Part A is free when one worked and paid Social Security taxes. Also, they must have paid taxes in 10 years. If not, they will have to pay monthly premium.

Part B Medicare

This plan is known as Medical Insurance. Basically, it covers most necessary medical services. Such as, preventive care and doctors’ services. They also include durable medical equipment, hospital outpatient services. Also, it covers mental health care and other home health services. One may pay a monthly premium for this coverage.

Part D Medicare

Medicare Part D is also known as Medicare Prescription Drug Coverage. This part provides outpatient prescription drug coverage. Further, this is only provided through private insurance companies. These companies must have contracts with the government. Therefore, it is never provided directly by the government.

One must choose Part D prescription plans that work with their Medicare benefits. For instance, if one has Original Medicare, they must opt for a stand-alone Part D plan (PDP).


What is Medicare Part C?

Medicare Advantage Plan means getting Part A and Part B Medicare. Basically, it covers all Medicare services. Most Medicare Part C also offers extra coverage. For example, vision, dental and hearing coverage. They provide significant coverage beyond Part A and Part B coverage. In some cases, coverage includes prescription drugs. However, not all.

Part C Medicare is not a separate benefit. This is a Medicare policy allowing private health companies to provide Medicare benefits. These private insurance companies are PPOs, HMOS and the like. In fact, one may choose getting Medicare coverage through Medicare Part C. That is instead of Original Medicare.

Furthermore, Medicare Advantage Plans must offer benefits almost same as Original Medicare. However, they can do so with their own costs, rules and coverage restrictions. They may also get Part D prescription plans as part of their Part C benefits package.

There are different kinds of Part C Medicare. Moreover, they pay a monthly premium for this coverage. That is in addition to their Part B premium.


How Does Medicare Advantage Work?

How does Medicare Advantage Work and Part D prescription plans

Medicare Part C must cover all services like Original Medicare. One can still get Original Medicare coverage if they have MA Plans. For instance, hospice care and other clinical benefits. Medicare Advantage Plans always cover emergency and urgent needed care.

Furthermore, the plan may choose not to cover costs that are not medically necessary. One may check with their provider before they get the service they want and need.

Usually, MA plans cover extra coverage such as hearing, dental, vision and other wellness programs. Most plans include Part D Prescription Plans. Clients usually pay an additional monthly premium to Part B.

Four Types of Medicare Advantage Plans

Private insurance companies provide Part C coverage. Medicare must approve these private companies. Furthermore, Medicare Advantage Plans include four different types of plans:

  • Health Maintenance Organization Plans (HMO)
  • Preferred Provider Organization Plans (PPO)
  • Medical Savings Account Plans (MSA)
  • Private Fee-For-Service Plans (PFFS)

The best thing about Part D prescription plans is their network. For instance, PPO plans allow one to choose from their network of doctors and hospitals. Also, they are allowed to visit providers outside the network. However, it is at a higher cost. In addition, one will have the ability to choose any specialists or doctors without referrals.

HMO plans also have a wide network of doctors. However, one may only visit doctors within their network. Likewise, they may choose primary care physicians under their network. Also, they must have a referral to see other specialists. When one chooses to get medical care outside their network, they must be responsible for paying the costs.

MSA plans offer two parts: high deductible health plan and savings account. Medicare annually funds the savings account with costs that covers one’s coverage. However, the amount is less than their deductible. This means, it requires one to pay some out-of-pocket before the plan begins to pay for Medicare-covered services. Further, one may not need to choose a primary care physician. Though one can receive health care from any doctor or hospital, their plan may have preferred providers.

Lastly, PFFS plans allow one to choose any health care specialists that are Medicare-approved. That is, as long as they agree to treat one and accept payment terms. This does not need a referral to see a specialist. Their plan has pre-determined rates for doctors and hospitals. In addition, they also have rates one has to pay for services.


Costs of Part C Medicare

One will be responsible for paying the premium for Part B. This ranges from $96.40 to $308.30 depending on one’s income. In addition, one may not pay an extra premium. This depends on the chosen plan. The government sponsors Part C Medicare. Although, extra services that includes in the plan can drive up costs. Basically, it breaks down as follows:

  • One must qualify for Part A and Part Medicare to get Medicare Part C. This means, one must at least pay a Part B premium. The standard Part B premium is $134 per month. Also, expect there will be increases in 2018.
  • The cutoff income amount for standard premium is $85,000. When one has a higher income, they may generally have to pay a higher premium.
  • Deductible costs $183 per year. This may increase in 2018.
  • One also pays a 20% coinsurance or 20% of all medical costs.
  • Part C Medicare has additional costs. This means one may pay a monthly premium for it as well. Also, these premiums vary but can be as low as $46 per month. Actually, The Centers for Medicare and Medicaid Services announces a decrease in 2018. It is an average of $30 a month.

Premiums may increase each year. Everyone can expect a decrease in advantage premiums in 2018. Further, the added costs are proportionate to the benefits they receive. Moreover, most plans include hearing, dental, vision, wellness program and prescription drug coverage.


Medicare Advantage Cost Sharing

Most MA plans combine co-insurance, deductibles and co-payments. These share the costs of the services one uses. Cost-sharing usually applies to most of the services the plan covers.

Further, most advantage plans have network hospitals and doctors that offer plan members discounted pricing. Every Part C plan has its own specific costs. However, the types of costs it includes are quite similar. Study the table below which shows the types of casts the plans may apply. Further, one must look at the details of a particular plan for actual costs.


Premium Monthly premiums may vary. One still has to pay the Part B premium to Medicare. Also, Part A premium if one has it.
Deductible One pays this every year. Actually, some plans charge annual deductibles. Some do not. Moreover, Part A and B deductibles do not apply.
Co-Payment Most plans charge co-payments for medical services and additional benefits. E.g. doctor visits
Co-Insurance Plans set their own co-insurance terms and percentages. This includes additional services such as durable medical equipment.


How To Enroll for Medicare Advantage Plan?

Signing up for Medicare is essential for saving money on one’s health insurance. With Medicare Advantage, one can still get plans for zero or little costs per month. However, they are sold through private health insurance companies.

One may enroll in Medicare Part C. They can do this during their eligibility period. In addition, they may enroll during Open Enrollment Periods. Moreover, there are designated times in a year when one can sign up for Medicare Advantage Plan.

Initial Enrollment Periods

If he/she is… Considerations When To Apply
A senior turning 65 Medicare Advantage Plan enrollment for the first time During the 7-month period of one’s 65th birthday:

·         three months before turning 65

·         the month turning 65

·         and three months after turning 65

Under 65 years with disabilities Medicare Advantage Plan enrollment for the first time Starting 21 months after one receives SSI or Railroad Retirement benefits; ends in the 28th month they get the benefits
Already under Medicare due to disabilities or turning 65 Enrolling for the first time in Part C Medicare; Switching from one MA plan to another; Dropping Advantage plan During the 7-month period of one’s 65th birthday:

·         three months before turning 65

·         the month turning 65

·         and three months after turning 65

Already under Medicare Part A but signs up for a Part B plan for the first time (during Part B general enrollment period) Medicare Advantage plan enrollment for the first time April 1 through June 30

There are other periods when one can make changes to their Part C Medicare. In fact, one may enroll in MA plan from an existing original Medicare plan.

Alternate Enrollment Periods

Enrollment Period Actions They Can Do
October 15 – December 7 ·         Changing from Original Medicare to Medicare Advantage

·         Change from MA plan back to Original Medicare

·         Change to a new MA plan from an existing MA plan

·         Switch from MA plan without drug coverage to another that offers drug coverage

·         Switch from MA plan with drug coverage to another that does not offer drug coverage

·         Enroll in Medicare Part D

·         Change from Part D plan to another plan

·         Cancel Part D prescription plans

January 1 – February 14 ·         Cancelling Medicare Advantage plan and enrolling in Original Medicare instead

The open enrollment period is October 15 through December 7. This is the period for big time beneficiaries. Other enrollment period is known as Medicare Advantage Disenrollment Period. Further, this is specifically for those cancelling their MA coverage. Then, their Medicare coverage will begin on the first month after they enroll. Furthermore, others add Part D when making the switch. Then, this coverage begins on the first month after their plan gets the enrollment form.

The disenrollment period is not for making changes to one’s MA plans. This is other than dropping MA plans or switching to Original Medicare. Moreover, one cannot use this period to make further changes. Therefore, October is the opportunity to change one’s coverage. Unless, they may qualify for a special enrollment period.


Medicare Advantage Plans vs. Medicare Supplement (Medigap)

Understanding Medicare Part C and Best Medicare Supplement Plans

Basically, Medicare Advantage plans are an alternative. When one enrolls in Medicare Advantage plan, they are still in the Medicare program. However, they may only get their benefits through Medicare Advantage Plan.

Furthermore, Medicare Advantage Plans provide coverage as Original Medicare. The best thing is they cover additional benefits.

Meanwhile, Medicare Supplement plans work alongside Original Medicare coverage. Both plans have significant differences relating to benefits, costs and how they work.

Med Supp works with Original Medicare. Further, it pays for certain costs. These are costs Original Medicare doesn’t cover. These plans do not provide stand-along coverage.

Therefore, one must stay enrolled in Part A and B for medical and hospital care coverage. One can get prescription drug coverage through Part D prescription plans.

Buying Medigap also means enrolling in Original Medicare. Primarily, Medicare pays one’s health-care bills. Meanwhile, best Medicare supplement plans simply cover certain cost-sharing expenses. These are Medicare-required expenses. For instance, copayments and deductibles.

Furthermore, Medigap helps with other costs. For example, they cover excess charges or emergency medical coverage when one travels outside the country. Remember that Medicare Supplement plans may only pay for Original Medicare. Therefore, they must not have Medicare Advantage Plans.


Getting Medicare Advantage Plan and Medicare Prescription Drug

Most Medicare Advantage Plan includes prescription drug coverage. These are also known as Medicare Advantage Prescription Drug (MAPD) plans. This plan is the total package.

Medicare Part D refers to prescription drug coverage. This is available as a stand-alone plan opposing Original Medicare. One may consider enrolling a stand-alone Medicare Part D. This boosts one’s Original Medicare coverage. Part D prescription plans are available through private companies. They must have Medicare approval.

One may add Part D Medicare if their Part C Medicare has no prescription drug coverage. However, one must inform their private insurance before making any changes.

Therefore, one cannot enroll in a stand-alone Medicare Part D if their Part C Medicare includes prescription drug coverage.



Medicare Part C is the option when one wants more coverage. This is provides an additional convenience for one’s health care needs. It is essential to look for Medicare coverage that fits one’s health care and budget. One may see a medicare agent to known which coverage is best.

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