What Is Medicare Part C And How It Can Impact Your Healthcare Needs? 

What Is Medicare Part C And How It Can Impact Your Healthcare Needs? 

Does “Medicare Program” describe the healthcare plan you received from your insurance agency, or are you looking for a package that includes all options? Usually, enrollees register for Part A and Part B Medicare, but Part C, also known as Medicare Advantage, is an optional health insurance program and a better choice than the Original Medicare.

Approximately 9.4 million people cover their medical expenses through Medicare Part C. Almost one-fifth of beneficiaries use this program for extra healthcare benefits. Patients leverage Medicare Part C because it covers Part A and Part B.

But, at best, it also offers additional services, including dental, vision, prescription drugs, and many others.
When a Part C plan, also known as Medicare Advantage Plan, includes prescription drugs, it is referred to as an MAPD (Medicare Advantage Prescription Drug Plan). We will discuss them in detail but first, let’s get a brief understanding of Part C.

Medicare Part C, Also Known As, An Advantage Plan? How Does It Work?

An additional insurance option, Medicare Part C, also called Medicare Advantage Plan, covers everything included in the national Original Medicare Healthcare Plan. Medicare-approved private companies assist people in finding the best type of program that suits their healthcare needs.

The MA plan usually includes Part D coverage that benefits patients in most healthcare situations. In addition, you can consult a healthcare service agent in your network to get brief information about its plan.

How do they help?

Healthcare agents participate in the plan’s network to present an outline of available Medicare Advantage Plans and Medicare Advantage Plans (Part C) set a limit for the payouts that one can pay for the chosen services. Furthermore, they also inform you about the non-emergency coverages offered by the programs.
Note: Don’t forget to use your MAPD (Medicare Advantage Prescription Drug) card to get
your Medicare-covered services. Moreover, keep your red, blue, and white cards safe. You’ll
need them when switching back to the Original Medicare Program.

What Does Medicare Advantage Plan Cover?

Medicare Part C covers all benefits offered in Part A and Part B Medicare. However, it may exclude hospice services, clinical trials, and some new benefits from the “National Coverage Determinations”. But if you’re enrolled in the MAP plan, Original Medicare will still cover the cost of clinical research studies, hospice care, and updated new Medicare benefits.

Another perk of choosing the MAP helps you get extra healthcare services which include:

  • During an inpatient stay, you can get home meal delivery.
  • Transportation service for a doctor’s appointment.
  • Gym membership
  • Drug prescriptions
  • Dental service
  • Vision service
  • Hearing aid and hearing service
  • Health and wellness programs
  • Over-the-counter drugs

What Are The Types Of Medicare Part C?

Most people enroll in the Part C plan because it includes comprehensive healthcare coverage. Therefore, we’re pleased to introduce its types to help you determine what to prefer specifically for your medical needs:

Health Maintenance Organization (HMO)

Under an HMO plan, the main objective set for the patients is to get preventative healthcare, to help individuals live healthier lives. Generally, a plan’s network provider helps beneficiaries get care and services in the HMO. In most situations, referrals are required for specialists, and the patient’s health is coordinated through their primary care physician (PCP).
In some plans, a beneficiary gets the privilege of finding services out of the network, but it may cost more than a regular network service. Most Medicare Advantage plans include Part D (Prescription Drug Coverage) at no additional cost. This is extremely useful in avoiding Part D late enrollment penalties by opting into a Medicare Advantage plan. HMO networks tend to have a lower max-out-of-pocket, MOOP, than PPO plans.

Remember, HMOs;
● Don’t cover out-of-area dialysis.
● In most cases don’t cover out-of-network providers.
● In the case of emergencies, out-of-network providers will be considered In-Network!
● Referrals are required when needing to see a specialist.

Note: A max-out-of-pocket, is the maximum possible expenditures possible on a plan. After you hit the max-out-of-pocket limit, every covered medical service after that limit is 100 percent covered at no cost to the patient.

Preferred Provider Organization (PPO)

PPO is another significant Medicare Advantage Plan offered by government-registered Medicare Caretakers. This plan covers network doctors, hospitals, and providers, along with prescription drug coverage plans, which are the primary featured services.
What’s the benefit of choosing PPO?
This plan is not costly for the patients who use services that belong to the plan’s network. You’re also covered for urgent care and emergency under the PPO plan. In PPO networks referrals are not required. In a PPO network, you may see out-of-network providers, but they will be more expensive than the in-network options. PPO networks tend to have a higher Max-Out-Of-Pocket also referred to as MOOP.

Private Fee-for-Service (PFFS) Plans

Normally, PFFS plans don’t work the same way as Original Medicare or Medigap. In this plan, a beneficiary can identify how much he has to pay to the hospitals, healthcare providers, and doctors. The prescription drugs may be covered in PPO, but if they won’t, you can avail of Medicare Part D separately. Furthermore, in the emergency, doctors, hospitals, and healthcare providers must treat your health-related problems.

Special Needs Plans (SNP)

When it comes to treating special diseases or characteristics, Medicare SNP becomes your first-hand choice. Medicare SNP modifies benefits, drug prescriptions, and provider choices to meet the needs of the group they offer.
Who can enroll in the SNP?
People who live in institutions, including nursing homes or community centers, those who are eligible for both Medicare and Medicaid, or people who have specific chronic and disabling diseases (like HIV/AIDS, chronic heart failure, End-Stage Renal Disease (ESRD), dementia, and diabetes). An SNP plan can limit your membership further to chosen chronic disease. So, you can enroll for this plan at any time but consult your plan’s network before making a final decision for your healthcare needs.

How To Enroll In The Medicare Part C? 

Not all types of Medicare Part C work the same way, so before you choose any specific type, it’s essential to take time out and search Medicare Healthcare Plans near your area. Once you understand what the plan offers and how much it may cost annually, here’s how you can enroll:
Medicare.gov is the first step to start with. It will lead you to explore the plan that best meets your healthcare needs.
● You can also enroll online by visiting the plan’s website.
● Prepare yourself for paperwork. You can contact the plan or any registered platform to find the enrollment form. Fill out the form and return it to the plan.
● Collect the contact information of the Medicare Plan because different departments are handling different plans at a time.
● Another best way to enroll in the Medicare Advantage Plan is to find a professional agency that caters to Medicare healthcare programs.
Ready to get the care you need? STL Medicare Benefits provide free phone consultation.

What’s Required When You Complete Enrollment?

Initially, when you register for Medicare, you receive a “Medicare Card” in your welcome packet. The Medicare card shows an identity number, including the registered program detail and enrollment date. You need to provide this data after joining Medicare Advantage Plan.

Be Aware! Don’t Share Your Private Information With Plan Callers

To get enrolled in a specific plan, Medicare isn’t allowed to call beneficiaries directly unless someone puts a request to be called. In addition, it’s inappropriate to share financial information, including credit card numbers or the bank account number, over the phone.

Who Are Eligible For Medicare Advantage Plan?

First and foremost, you must register for Original Medicare before joining Medicare Advantage Plan. Following are the conditions that you must keep in mind to meet eligibility requirements in the MAPD:
● It will be better to live in the service area of the plan. This way, you’ll get more accurate information about your area. However, if you might be living in another part of the state, confirm whether your plan will cover or you have to pay expenses.
● A person is eligible when she/he already got enrollment in Part A and Part B Medicare.
● Another essential condition for enrollment is to be a U.S. citizen or should be lawfully present in the U.S.

Enroll, Switch, Or Drop MAPD With Medicare Experts

Enrolling. Switching. Dropping.
Several people register and switch plans when they don’t need the previous chosen plan. So, if you’re already registered for the MAPD, here are the two ways to switch to another plan:
● When you switch to a new plan, you must select the right type during enrollment. Hence you will automatically be disenrolled from the previous plan when a new coverage period starts for the chosen plan.
● Wait for the MAPD Open Enrollment Period (OEP) from January 1 – March 31 each year. You can switch, enroll, or drop your current plan during this phase. This can happen with or without Part D (Drug Coverage Plan).
● Wait for the Annual Enrollment Period (AEP) from October 15 – December 7th each year. During this period you can make multiple changes to your Medicare coverage.

Cost & Rules For Medicare Advantage Plan 

Before joining any specific MAPD type, you must learn its rules and cost structure. The cost of MAPD varies depending on the plan category you choose for your healthcare routine.
Let’s determine the factors on which your out-of-pocket cost depends:

  1. Compared to the Original Medicare, most MAPD plans have a $0 premium. So, if you pick a plan that charges a premium, it will be considered an addition to Part B or Part Premiums, especially when they’re not premium-free.
  2. Some of the MAPD plans may give a Social Security “giveback” for Part B. Usually, they’re not available in all areas. This process is called “Medicare Part B giveback”.
  3. When any of your plans have additional deductibles or yearly deductibles.
  4. Copayments and coinsurance for each visit or service vary by the type of provider. For instance, the plan may cover primary care physicians with a $0 copay, while your specialist visits may be $25/visit.
  5. The cost of MAPD plans also depends on the type of healthcare services and how often you use them in your daily routine.
  6. Part C cost also depends on following the plan’s rules, like using in-network providers’ help to receive specific healthcare services, as opposed to the more expensive out-of-network providers.
  7. When you need the extra benefits and plan charges for it.
  8. When you have also registered for Medicaid and get help from your state.

When you have also registered for Medicaid and get help from your state. Remember, if you’re registered for any specific type of MAPD plan, the plan will send you the necessary documents and detail, including EOC (Evidence of Coverage) and ANOC (Annual Notice Of Change). Furthermore, choosing Part C is a good option when you need additional healthcare services. It also includes a yearly cap, also known as Max-Out-Of-Pocket that, once touched, can help you avoid cost-out-of-pocket for the chosen plan.

Rules For Medicare Part C

Private insurance companies offering MAPD plans get financial support for each month from Medicare. Each plan can charge different out-of-pocket costs from the beneficiaries varying from plan to plan. Therefore, Medicare sets rules for these companies that are offering MAPD plans. Moreover, they also set different rules for how you get coverage or medical facilities, like:
● A need for referral to see a specialist or a doctor.

How Do Medigap Policies Work With Medicare Advantage Plan? 

During enrollment in the Medicare Advantage Plan, you can’t join, nor can you pay through Medigap for any medical service. Under these circumstances, a person has to drop Medigap when he intends to enroll in the MAPD plan. Medigap policies don’t work with the MAPD plans, and even it’s illegal for private companies to sell a Medigap program to a beneficiary with an MAPD plan.
With that in mind, a person can get a Medigap plan if they drop their MAPD or unless he decides to switch back to just their Original Medicare. The members of the Medicare Advantage Plan get a special right under Federal Law to buy a Medigap policy when they have joined MAPD for the first time and are not satisfied with the results. Hence, you can use these rights only when switching back to Original Medicare within 12 months of joining.

Advantages and Disadvantages of Medicare Part C

Medicare Part C is the comprehensive plan that offers almost every service the Original Medicare provides. But, we will discuss the pros and cons to help you make a better decision regarding healthcare needs.

Pros Of Part C Cons Of Part C
MAPD plans provide coverage for the
additional services not offered in the Original
An enrollee may pay two premiums for
Part B and Part C.
Most MAPD plans contain Prescription Drug
Coverage Plan (Part D).
MAPD plans with HMO networks may
require referrals to specialists.
Low monthly premiums are available in
different types of MAPD plans.
Plans may not have every provider
Reducing waiting time for the appointments
because a person can avail of
out-of-the-network services too.
You may not be able to use your MAPD in
other states for everyday health services,
unless it is an emergency
Yearly caps out-of-pocket expenses covered. Only certain periods when you can make
changes to these plans.

How Can STL Medicare Benefits Help? Here’s How We Give MAPD Assistance.

Quality Representatives. We know the market and the available plans.
Looking for the best-personalized care for your loved ones? STL Medicare Benefits backs up every care visit with years of experience delivering over billion hours of marvelous service, including meeting deadlines for enrollment, offering Medicare plans, and sharing news regarding copayments, deductibles, premiums, and free-healthcare consultation.
Here are some key points that we consider while guiding our clients regarding Medicare part C:

  1. Coverage Type
    If your current coverage doesn’t contain healthcare services in Part A and Part B, we help you
    find a plan that covers all services that might be essential and may not cost you more than the
    Original Medicare.
  2. Plan Type
    After hearing your personal healthcare preferences, we guide our clients about the MAPD
    plan, including HMO, PPO, PFFS, SNP, and MSA. This way, you get to choose the right category of Medicare Part C.
  3. Supporting Low Incomers
    Private insurance companies associated with STL Medicare Benefits offer many options to support low financial cases. We suggest the best strategy to plan your out-of-pocket costs for the plans.
  4. Unique Medical Needs
    The unique health situation is one of the reasons why we cater to our clients with personal care. So, what do we consider before introducing any plan? We explore healthcare conditions and needs, frequent travels, and special equipment needed regularly.

We’re STL Medicare Benefits, the most trusted senior health caretaker in your area. If you need further information regarding MAPD plans, be our guest. We’ll help you find the best plan for your budget and healthcare needs.

The Takeaway

We will like to conclude this article by sharing some useful takeaways that will summarize what we have discussed so far regarding Medicare Part C:
● Medicare Part C, also known as Medicare Advantage Plan, offered to help you get additional services that aren’t offered in the Original Medicare.
● It’s an excellent choice for people interested in the coverages, including prescription drugs, dental services, vision care, and more.
● The cost structure of MAPD depends on various factors like copayments, medical needs, and monthly or yearly Max-Out-Of-Pocket.
● Part C also covers preventive services like screenings and exams not covered in the Original Medicare.

We´re proud to represent insurers such as:

aetna american continental medicare supplement
anthem medicare supplemental rates
bluecross blueshield medicare
cigna health insurance
healthspring medicare advantage plans
humana medicare part d
united health one
wellcare medicare advantage plans