How Do Medicare Part C Plans Work
Medicare Advantage plans all offer you care through a network of health care providers. Plans are divided into multiple types based on whether you can use providers outside of your network and how much you would have to pay for doing so. This is the same system that other private insurance plans use. Plans may not advertise very clearly what type they are, so make sure to check the plan details for more information.
The table below lays out the major features for each type of Medicare Advantage, and then we go into more detail on each one.
Contact Social Security To Sign Up For Medicare
You can either:
Know when to sign up for Part BYou can only sign up for Part B at certain times. If you dont sign up for Part B when you turn 65, you might have to wait to sign up and pay a monthly late enrollment penalty. Find out when you can sign up. How much is the Part B late enrollment penalty?
What Else Should I Know About Medicare Part D
Either way you decide to get Medicare Part D coverage, there are a few things to keep in mind:
- Not every plan will cover every prescription drug. If youâre on medications, you might want to make sure your Medicare prescription drug plan covers them. Each plan has its own formulary â thatâs a list of prescription drugs the plan covers.
- Even if you find a plan that covers your prescriptions, know that a plan may change its formulary anytime. Your plan will notify you when necessary.
- Every fall, your plan will send you Annual Notice of Change and Evidence of Coverage documents. Check to see how your coverage may be changing next year, including if any of your medications will be dropped from the formulary, or if your costs are going up.
- You donât have to sign up for prescription drug coverage under Medicare Part D. But if you decide to sign up after your Medicare Initial Enrollment Period, you could face a Part D late enrollment penalty.
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How Medicare Part C Works
Medicare Part C includes your Part A and Part B benefits. The only exception is hospice care, which is still covered under Part A. Many Medicare Advantage plans offer additional coverage beyond Original Medicare. Some of those benefits might include:
- Routine dental care
- Wellness programs called SilverSneakers
- Prescription medications
Medicare Part C plans can also offer additional benefits today, such as over-the-counter medications, transportation to and from doctor appointments, and adult daycare services.
Do You Pay Federal Income Tax On Your Social Security
Some people who get Social Security must pay federal income taxes on their benefits. However, no one pays taxes on more than 85% percent of their Social Security benefits. You must pay taxes on your benefits if you file a federal tax return as an individual and your combined income exceeds $25,000.
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Paying A Premium For Medicare Part C
A premium is an amount you pay each month to purchase your coverage . Some Medicare Part C plans have premiums, while others do not.
People with Medicare Part C still have to pay the monthly premium for Medicare Part B since the Part C plan provides the benefits of Medicare Part A and Part B combined into one private plan.
For most Medicare beneficiaries, Medicare Part A does not have monthly premiums. But for those who don’t have enough work history to qualify for premium-free Medicare Part A, there will be a premium for Part A as well as Part B.
In 2022, the Part B premium for most Medicare beneficiaries is $170.10/month . So most people with Medicare Part C have to pay at least that amount for their coverage.
As of 2022, 59% of Medicare Part C plans have no additional premium other than the premium for Part B, and these are the plans that tend to be favored by Part C enrollees. The majority of these plans also include Part D coverage in addition to the Part A and Part B benefits, but the beneficiaries only pay the premium for Part B.
Some of these plans even have a “giveback” rebate that pays a portion of the Part B premium on the enrollee’s behalf. So in some areas, it’s possible to have Medicare coverage under a Part C plan and pay less than the standard Part B premium each month.
The other 41% of Part C plans have a premium that has to be paid in addition to the Part B premium. These premiums vary from one plan to another.
What Is The Annual Election Period
The annual election period is the interval in which Medicare beneficiaries can make changes to their coverage. It is also called the annual enrollment period or Medicare open enrollment.
The AEP dates run from October 15 through December 7. During this time, people can change between Original Medicare and Medicare Advantage plans, or between the various Medicare Advantage plans.
Individuals may also change from one Medicare Part D plan to another or enroll in a Part D plan if they did not do so when they were first eligible.
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Is Medicare Part C Being Discontinued
No, Medicare Part C is not being discontinued. However, there are other types of plans that may be sold by private insurance companies to help fill gaps in Original Medicare called Medicare Supplements or Medigap plans. As of January 1, 2020, Medigap Plan C is not available to those who are new to Medicare.
Can I Get Medicare At Age 62
Retirement and Medicare typically go hand in hand. So, if you retire at age 62 are you eligible to enroll in Medicare? Unfortunately, you would not be eligible for Medicare if you retire at age 62. You can typically get Medicare at age 65.
If you retire before age 65, you may be eligible for Social Security benefits at age 62, but that will not allow you to enroll in Medicare coverage. You will need to wait until your Initial Enrollment Period begins three months before your 65th birthday to begin the Medicare enrollment process.
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Will The Medicare Age Be Raised To 67
In recent years, the proposal to raise the Medicare eligibility age to 67 began to gain traction. However, many are actually in favor of lowering the Medicare age below 65 rather than pushing it back to 67.
As of now, there has not been any indication that either of these proposals will become law. The standard Medicare enrollment age is currently 65 and there are no plans of changing that in the near future.
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Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.
Medicare Part C Basics
First, the basics. Medicare is a federal program that guarantees health insurance for people age 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease requiring dialysis or kidney transplant.
Medicare is comprised of four distinct programs. Medicare recipients may choose to obtain their health care either through the “Original” Medicare Parts A and B or through private insurance plans, called Medicare Advantage Plans , under Medicare Part C. Medicare Part D provides prescription drug coverage.
Under Part C, Medicare Advantage Plans must offer its enrollees, at a minimum, the same Medicare-eligible health care services available to beneficiaries under Original Medicare Parts A and B. In addition, MA Plan enrollees are entitled to additional services not generally available to beneficiaries under Original Medicare without additional charge to the enrollee. This may include coverage for vision, dental, or hearing services. In exchange for receiving the additional coverage at no extra charge, the enrollee is generally required to obtain health care services from providers within the MA Plan’s network. MA Plan enrollees are covered for out-of-network care, however, when they require emergency and/or urgent care.
For those who don’t want managed care, an alternative to an MA Plan is to buy Medigap insurance to pay for services not covered by Medicare.
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How Do I Join A Medicare Part C Plan
You must choose to join, or opt in to, a Medicare Part C Plan. You can only join a plan at certain times of the year and generally will stay enrolled in the Plan for the entire year. There are special dates you can change plans.
For more information on joining a plan, visit www.medicare.gov/publications to view the fact sheet Understanding Medicare Enrollment Periods. You can also order a copy can be mailed to you online, or call 800-MEDICARE.
The Future Of Medicare Advantage
If you depend on Medicare for your healthcare, then you must compare plans each year before the open enrollment period begins on October 15. Researching your options well in advance ensures that youll get the best value for your budget and needs. As HMO plans are on the rise with Medicare Advantage, you also may think about switching back to original Medicare if you prefer a wider selection of doctors.
Overall, Medicare Advantage continues to be the lower-cost option, with more value for those who need to cover basic and more serious healthcare needs.
There are a few other types of plans that youll find sponsored by the government under Medicare Part C. Its best to choose a plan based on your specific needs and always look for the plan that offers the most services for the premium that you pay. If your budget isnt that big, you may want to stick to basic services or choose a PFFS plan.
Enrolling in Medicare Part C can only be done at certain times of the year or when you first become eligible for Medicare. Please visit HealthNetwork.com to compare Medicare Advantage plans and get connected with a licensed sales agent that can provide you more information on your Medicare options.
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Medical Savings Account Plans
MSAs are a bit different from the types of plans above. An MSA works very similarly to a high-deductible health plan paired with a health savings account . With an MSA plan, Medicare will deposit money into an account that you can then use to pay for your health care services. Your insurance will not start to pay for your medical expenses until you spend enough to hit your deductible.
Deductibles vary by plan, but can be thousands of dollars. If you spend all of the money in your MSA before reaching your deductible, you will need to pay expenses out of pocket until you hit your deductible. Make sure to take the high deductible into account before getting an MSA.
What Types Of Medicare Advantage Plans Are There
Coordinated Care Plans
Most Medicare Advantage plans are coordinated care plans. Coordinated care plans have a network of doctors and providers. If you use the plan’s network doctors and providers, you generally pay less out-of-pocket for care.
Health Maintenance Organization plans
HMO plans use a network primary care provider to help coordinate care. HMO plans usually only pay for doctors and providers in the plan network.
Point of Service plans
POS plans have the benefits of an HMO, but with more flexible doctor/provider choice. Costs are generally lower for using in-network doctors/providers.
Preferred Provider Organization plans
PPO plans cover doctors and providers both in and out of network. These plans pay a portion of the cost for using an out-of-network doctor or provider.
Special Needs Plans
Special Needs Plans have benefits that cover special health care or financial needs. All SNPs include prescription drug coverage.
- Dual-Eligible Special Needs Plans for people who have both Medicare and Medicaid
- Chronic Special Needs Plans for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
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Should I Enroll In Medigap
If you are enrolled in Medicare Part C, you do not need a Medigap plan .
If you have Original Medicare plus a Medigap plan and want to switch to Medicare Advantage, you’re allowed to keep the Medigap plan. But you will not be able to use it while you have Medicare Advantage, and you would have to continue paying monthly premiums to maintain the Medigap plan.
Keeping it would only be useful if you were to decide later that you wanted to return to Original Medicare and had health conditions that would make you ineligible to re-enroll in a Medigap plan.
Note that you have a one-year trial right period in such situations. You can drop your Medicare Advantage plan, return to Original Medicare, and re-enroll in the Medigap plan without medical underwriting . It’s unnecessary to keep your Medigap plan “just-in-case” while you test out a Medicare Advantage plan for less than a year.
You’ll want to keep the long-term picture in mind when enrolling in Medicare. Although there’s an annual open enrollment period each fall when you can switch your Medicare Part C and D coverage, there is no similar ongoing enrollment opportunity for Medigap plans.
In most states, you only have one six-month window , during which you can enroll in Medigap without medical underwriting.
These are important factors to keep in mind when you’re enrolling in Medicare you want something that fits your budget and lifestyle but will also keep up with your needs in later years.
What Is Covered Under Medicare Part C
Medicare Part C plans have the benefit of being administered by private companies, which means that they can add more services. As a rule, these plans must offer the same coverage as you would receive under Original Medicare. Certain services must be covered, which include the following:
- Hospital stays
- Lab tests
- All benefits of Part B
Most Medicare Advantage plans do not offer hospice care, which is available under Original Medicare. The same goes with prescription drug coverage. While many plans will include this benefit, they do not have to include Part D in any plan. You can still purchase Part D separately if you want prescription drug coverage. Vision, dental and hearing care may be included, but these are considered extras. Premiums may be higher with added services, like wellness programs, nurse helplines and dental care.
When you look at a plans benefits, check for extra services as well as the plans rating. Many higher-rated plans will feature additional benefits along with a higher customer satisfaction rating. Medicare keeps track of Advantage plans and rates them based on different factors, with 5-star plans being the best. The Medicare Plan Finder tool lets you find and compare plans with good scores so that you know what youre buying ahead of time.
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Health Maintenance Organization Plans
Medicare Advantage HMOs are insurance plans that only cover services within your network of providers. If you go outside of that network, your insurance will not cover any medical expenses you incur. The only exception is for emergency services, which all plans must cover even if you go out of network.
The other major feature of a health maintenance organization is that you are required to select a primary care physician . Your PCP is the person who all your care goes through. For example, your insurance will not pay for you to see a specialist physician unless your primary care doctor refers you to that specialist.
Learn more about how HMOs work.
One subset of HMO plans to note is an HMO point-of-service plans . An HMOPOS allows you to get some services out-of-network for a higher copayment orcoinsurance.
How Do I Apply For Medicare Part C
You can apply for Medicare Part C a number of ways, including visiting the plans website, filling out a paper enrollment form, or calling the plans phone number. Additionally, HealthMarkets can help you compare Medicare Advantage plans online and begin the application process.
With the yearly changes affecting the cost of Part C Medicare, its important to make sure you have the most up-to-date information about your benefits and coverage. HealthMarkets can consider your unique insurance needs to help you find the right Medicare Part C plan, at no cost to you. Get started comparing plans online today, or call 986-2752 to speak to a licensed insurance agent.
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How To Apply For Medicare Part C
First, enroll in Original Medicare . You cannot enroll in Medicare Part C until you do this. If youre on federal retirement benefits, meaning you have paid Medicare tax through your payroll taxes for at least 10 years, youre automatically enrolled in Medicare on the first day of the month you turn 65. Youre also automatically enrolled once youve been receiving federal disability payments for 24 months regardless of your age.
If youre 65, but not receiving federal retirement benefits, you have to enroll for Medicare by visiting your local Social Security office, calling 1-800-772-1213, or filling out an online application through the Social Security Administration website at ssa.gov.
Once youre enrolled in Original Medicare, then you can shop for a Medicare Advantage plan. You can search for plans on the Medicare website and purchase the one you want directly from the insurer.
However, you can only enroll within a designated time period each year. New Medicare recipients have seven months to buy coverage, starting three months before the month you turn 65. This is your initial enrollment period. Outside of initial enrollment, these are the times you can purchase or make changes to a Medicare Advantage plan:
Learn more about how to apply for Medicare.