Medicare Part C Coverage

Medicare Part C is also called Medicare Advantage (MA) and it is an alternative program to Original Medicare. Part C was first introduced as part of the Balanced Budget Act of 1997. The goal of that Act was to provide privately run health plans as an alternative to the government Medicare Program. By law all Medicare Advantage Part C Plans must provide coverage that is substantially similar to Part A and Part B coverage. Many Part C Plans also include prescription drug, hearing, vision and dental coverage. Part C coverage cannot be used with Medigap policies. Moreover, Part C cannot be used in conjunction with Part D prescription drug plans unless prescription drug coverage is excluded from the Part C Plan.

Medicare Part C coverage also requires the user to pay premiums, co-pays and deductibles. All Part C plans exclude hospice care but this is still covered by anyone enrolled in a Part C Plan by Original Medicare.

There are a variety of Medicare Advantage Plans to choose from. Plan types include Health Maintenance Organization (HMO) Plans, Preferred Provider Organization (PPO) Plans, Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), HMO Point-of-Service (HMOPOS) Plans and Medical Savings Account (MSA) Plans.

Medicare Part C coverage is substantially different from Original Medicare coverage because private insurance companies run these plans. The doctors and medical providers are usually limited to a Preferred Provider Network. If you want to use a doctor or provider outside of the network you will generally pay more.

Medicare Part C coverage is location specific. Usually these plans only have Preferred Providers within a fixed geographic region. If you travel regularly Part C coverage may not adequately meet your needs. Urgent and emergency care is usually covered under Part C Plans but coverage for most other types of care outside of your service area can be very limited.

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Most Medicare Part C plans include prescription drug coverage and many of them include coverage for hearing and vision care not included under Original Medicare. Some of these plans also include extras such as gym memberships.

Medicare Part C Plans have much stricter rules than Original Medicare. Moreover, the rules vary from plan to plan. These plans give you many options for managing your care but choosing the right plan will take some thought and investigation.

In summary, Medicare Part C coverage is required by law to offer substantially the same coverage as Part A and Part B. However, private companies manage these plans and the co-pays, deductibles and premiums can fluctuate plan to plan. In many cases Part D, prescription drug coverage is included in Part C Plans. Part C plans cannot be used with Medigap policies or in addition to Part D Plans if they include prescription drug coverage. These plans provide many different alternatives for managing your care and it will take some research to get the best plan for your personal needs.