Should I Get A Medicare Part C Plan
Enrollment in Medicare Part C plans has been growing, largely because Advantage plans offer more benefits than standard Medicare plans. Medicare Advantage plans usually arent the best option for low-income recipients because they can often qualify for other Medicare savings programs. Medicare Advantage also isnt generally necessary if youre still receiving employer-sponsored coverage.
Pros of Medicare Part C
Provides coverage for services Original Medicare does not, like vision or dental
Usually offers prescription drug coverage
Caps out-of-pocket expenses, unlike traditional Medicare
Cons of Medicare Part C
Likely have to pay two premiums, one for Medicare Part B and one for your Advantage Plan
Many types of individual plans, each with their own rules on the coverage and costs for using out-of-network providers
Your network of available health care providers is smaller than with Original Medicare plans
Not all in-network providers are necessarily accepting new patients
Cant be used in conjunction with employer-sponsored health care benefits that supplement Original Medicare
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Derek is a former senior editor and personal finance expert at Policygenius, where he specialized in financial data, taxes, estate planning, and investing. Previously, he was a staff writer at SmartAsset.
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Who Is Eligible For Part C Medicare
You may be eligible for Part C Medicare if the following applies:
- Enrollment in Medicare Parts A and B
- Residence in the Medicare Advantage plans service area
So, before you can even qualify for a Medicare Advantage plan, you must first be eligible for Medicare.
You may be eligible for Medicare if one or more of the following applies to you:
Signing Up For A Medigap Policy
To purchase a Medigap supplement insurance policy, you must first enroll in Medicare Part A and Part B.
The best time to enroll in a Medigap plan is when you are first eligible.
This is a six-month enrollment period that begins the month youâre 65 and enrolled in Medicare Part B.
If you apply for Medigap coverage after this six-month window, private insurance companies may not sell you a policy if youâre in poor health.
You can find a Medigap policy by using an online tool on the Medicare website, contacting your local SHIP or calling your State Insurance Department.
How to Sign Up for a Medigap Policy Online
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How Does The Government Rate Medicare Advantage Plans
Medicare beneficiaries who have Medicare Advantage plans are more likely to pick a plan with a higher star rating than one with one or two stars according to recent findings. Ratings have a significant impact on the plans that are most popular for Medicare recipients they also help members pick plans with better offerings.
Studies also show that ratings make a difference to consumers because quality matters. With the creation of the online plan quality and ratings finder on Medicare.gov, anyone can quickly find top-rated Medicare Advantage plans for their service areas. However, its important to understand how these plans are rated and what the government looks for when determining the quality of a health insurance plan. Ratings for Medicare plans are based on the following:
- Screenings, tests and vaccines
- Member complaints, improvements, plan performance and issues getting service
- Customer service
Medicare drug plans that are separate from Medicare Advantage are rated slightly differently. These plans are rated according to the following:
- Patient safety and drug pricing accuracy
- Drug plan customer service
- Member complaints, problems with getting drugs and improvements in performance
- Member experiences with the plan
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.
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How Do I Enroll
You can enroll online, call us, or even fax or mail us. Be sure to review our Enrollment Disclaimers before you sign up.
Finding the right plan is easy with Cigna online enrollment. You can compare and choose one that fits your needs.
Compare plans and enroll online
Medicare beneficiaries may also enroll in Cigna Medicare Plans through the Centers for Medicare & Medicaid Medicare Online Enrollment Center .
You can enroll in a Cigna Medicare Advantage plan by calling us toll-free and talking with one of our licensed health agents.
7 days a week, 8 am – 8 pm
You can use our chat messenger on weekends from April 1 to September 30.
Using our enrollment tool , enter your ZIP code and select the plan youre interested in. Once youve selected your plan, find the Enrollment Form for that plan under Plan Documents. Print and complete the form. Mail or fax your completed and signed forms to:
Medicare Advantage Plans – All Locations EXCEPT Arizona
Member Administrative Services
Fax: 1 785-7444
Medicare Advantage – ARIZONA ONLY
Fax: 1 531-9754
1Not all Medicare Advantage Plans include Part D prescription coverage.
Preferred Provider Organization Plans
A Medicare Advantage PPO offers more flexibility than an HMO because your insurance will usually cover out-of-network providers. It will cost you more than what you would pay if you went in-network, though. PPOs also dont require a primary care physician and they allow you to see a specialist without a referral.
Sign Up: Within 8 Months After Your Family Member Stopped Working
- Your current coverage might not pay for health services if you dont have both Part A and Part B .
- If you have Medicare due to a disability or ALS , youll already have Part A coverage.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty until you turn 65. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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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Consolidate Your Coverage With A Part C Medicare Plan
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Medicare Part C allows private insurance companies to sell health plans that provide Medicare benefits. Also known as Medicare Advantage, these plans are regulated by the Medicare program and can keep your medical, hospital, and prescription drug needs under one umbrella. But each plan can vary, so its important to make sure it provides the coverage you need before enrolling.Want to learn more about Medicare Advantage? This guide will break down some important considerations to keep in mind as you shop for a plan.
What Isnt Covered In Medicare Advantage Plans
While Medicare Part C must cover the same services as Original Medicare, it doesnt have to provide coverage for hospice care. But even if your plan doesnt cover this, its still included as part of your Medicare coverage. Thats because youre still technically enrolled in Medicare when you have a Medicare Part C plan. You can still have Medicare Advantage and continue to receive hospice care through Original Medicare.
Medicare Advantage plans will take care of all benefits that arent related to your hospice care. Some plans may include extras, like vision and dental, but these benefits are not required by law. Theyre considered extra costs and may only be available in certain areas.
Each plan has different limits as well. To ensure that you find the best plan, its important to compare as many options as you can to see which plan works best for your health care needs.
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How And When To Enroll In Medicare In 2022
The Medicare fall open enrollment period has ended, but if you are enrolled in a Medicare Advantage plan rated lower than five stars but you find a five-star plan in your area, you may be able to switch to the five-star plan at any time between December 8 and November 30 of the following year. This is called the five-star Special Enrollment Period. Compare plan Star Ratings online or speak to a licensed insurance agent today to switch to a 5 star Medicare Advantage plan if you’re eligible by calling 1-877-566-7380TTY Users: 711. We accept calls 24/7!
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.
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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.
Plans Have Variable Benefits
Even though the same set of services is covered by Medicare Part C and Original Medicare, the level of benefits with Medicare Part C may vary.
For example, Original Medicare benefits are standardized, and youll usually pay 20% of the cost for doctor services. On the other hand, a Medicare Part C plan will have a specified copayment or coinsurance for each covered service. With one plan, a medical service could cost just $10, and if you have the same medical service with another plan, you could pay 40% of the bill.
Because of this variability, it’s important to choose a health plan that has strong coverage for your expected health needs. For example, if you expect to need a joint replacement in the upcoming year, compare plans based on their inpatient hospitalization benefits and access to physical therapy.
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What Is Medicare Advantage
Medicare Advantage, or Medicare Part C, is a type of Medicare plan that uses private health insurance to cover all the services youâd receive under Medicare Parts A and B. Anyone who is eligible for original Medicare Parts A and B is eligible for the Medicare Advantage programs in their area.
People who choose Medicare Advantage plans may enjoyâ¦
One stop shopping: Dental care, prescription drugs, vision care, and other important benefits may all be included in your Medicare Advantage Plan.
Potential savings: Medicare Advantage Plans have out-of-pocket limits on costs associated with your care, while original Medicare does not.
Long-term care services: While original Medicare doesnât cover long-term care like meal delivery and specialized home care, many Medicare Advantage plans do.
There are four main types of Medicare Advantage plans, which you can choose based on your needs: Health Maintenance Organization Plans , Preferred Provider Organization Plans , Private Fee-for-Service Plans , Special Needs Plans . Home Point of Service Plans , and Medicare Medical Savings Account Plans are also less-common types of Medicare Advantage plans.
Though often confused with Medicare Supplement plans, Medicare Advantage plans are run by private insurers and function like traditional health insurance. You cannot have both Medigap and Medicare Advantage at the same time, so itâs up to you to figure out which type of plan works best for your needs.
Medicare Advantage Plan Enrollment
When youre eligible to enroll in Original Medicare, you also become eligible to enroll in a Medicare Advantage plan. You need to enroll in Original Medicare before you enroll in Medicare Advantage. Before enrolling in a plan, it may be a good idea to compare Medicare Advantage quotes.
To be eligible for Medicare Part C, you must already be enrolled in Part A and Part B.
If you are interested in joining a Medicare Advantage plan, you typically can only do so during specific times of the year.
The first time you may be able to enroll is during your Medicare Initial Enrollment Period, as outlined above.
If you sign up for a Medicare Advantage plan during your Initial Enrollment Period, you can change to another Medicare Advantage plan or switch back to Original Medicare within the first 3 months that you have Medicare.
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When Can You Sign Up For Medicare Advantage
There are specific times during the year when you can sign up for a Medicare Advantage plan. These are HMO and PPO plans or Part D coverage plans that you can sign up for with a private health insurance carrier. In addition, you can only make changes to your coverage during certain parts of the year. Initial enrollment periods are as follows:
|Turning 65 for the first time||Enroll in a Medicare Advantage plan for the first time||During the 7-month period surrounding your 65th birthday|
|Under 65 and disabled||Enroll in a Medicare Advantage plan for the first time||Beginning 21 months after you start receiving SSI or Railroad Retirement benefits and ending the 28th month you get those benefits|
|Already enrolled in Medicare due to disability and you turn 65||Enroll in a Medicare Advantage plan for the first time -OR-
Switch from one MA plan to a different one -OR-
Drop your Advantage plan entirely
|During the 7-month period surrounding your 65th birthday|
|Already enrolled in Medicare Part A but sign up for a Part B plan for the first time during the Part B general enrollment period||Enroll in a Medicare Advantage plan for the first time||From April 1 through June 30|
The above table is for initial enrollment periods. There are other times when you can make changes to your Medicare Advantage plans or enroll in an MA plan from an existing Original Medicare plan. Alternate enrollment periods are as follows:
Medicare Initial Enrollment Period
The earliest time you can enroll in Original Medicare, a Medicare Advantage plan or a Medicare Part D prescription drug plan is during your Medicare Initial Enrollment Period .
Your Initial Enrollment period lasts for seven months:
- It begins three months before you turn 65
- It includes your birth month
- It extends for another three months after your birth month
If you are under 65 and qualify for Medicare due to disability, the 7-month period is based around your 25th month of disability benefits.
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Sign Up: Within 8 Months After The Active Duty Service Member Retires
- Most people dont have to pay a premium for Part A . So, you might want to sign up for Part A when you turn 65, even if the active duty service member is still working.
- Youll pay a monthly premium for Part B , so you might want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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:
- 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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