What is Medicare Part C?

Part C, more commonly known as Medicare Advantage (or MAPD plans when they include prescription coverage), allows private health insurance companies, such as Priority Health, to provide Medicare benefits in addition to what’s covered by Parts A and B. These plans include HMOs, POSs and PPOs, known as Medicare Advantage plans, or MAPD plans when they include the aforementioned prescription coverage from Part D. In short, they offer everything Original Medicare does, plus a lot more. 

Why enroll in Medicare Part C?

Medicare Advantage can help lower your out-of-pocket costs with predictable copayments, lower deductibles and out-of-pocket maximums. In addition to helping cover prescription drugs, MAPD plans can also offer extra benefits, such as gym memberships or dental coverage.

What does Medicare Part C cover?

Coverage under Part C is very similar to that of typical health insurance plan, however it also offers dental, vision and other coverage benefits that may not be found in Parts A and B.

How much does a Medicare Part C plan cost?

As usual, Medicare plan costs can vary person to person. However, if you are feeling as though a Medicare Advantage plan is right for you, you should thoroughly consider your financial position. 

Advantage plans tend to be a great option for Medicare-eligible individuals who are looking to save money each month, but tend to have lower coverage needs. Typically with any health insurance plan, the lower the premium, the higher the deductible. Since an Advantage plan would entail a $0 premium, you could be paying more, especially factoring in aspects like prescription costs.

Members with continuing curiosity about what they could pay with an Advantage plan are also encouraged to utilize our Cost Estimator tool. 

Am I eligible for Medicare Part C and how do I qualify?

If a Part C plan sounds like the right thing for you, you can follow the normal application process. However, the normal Medicare enrollment factors still apply:

  • You must have both Part A and B Medicare to enroll.
  • You must be a permanent Michigan resident and reside in our service area for at least six months of the year.
  • You can’t be denied for pre-existing conditions unless you’ve been diagnosed with end stage renal disease (ESRD).

When can I enroll?

You can enroll in Medicare Part C during any of the following periods:

Initial enrollment period (IEP). IEP is the seven month period that begins three months before your 65th birthday and enrollment in Parts A and B. During this time, you can elect to have just Original Medicare (Parts A and B) or add extra coverage with a Medicare Advantage or Medigap plan.

Annual enrollment period (AEP). AEP runs from Oct. 15 – Dec. 7 each year, and is generally the one time of year you can make changes to your plan. If you don’t already have a Medicare Advantage plan, you can choose to enroll in one during this time. If you are currently enrolled in a Medicare Advantage plan, you can choose a different plan. If you do decide to make changes, your coverage is effective on Jan. 1.

Special election period (SEP). These are periods of time outside of the ICEP or AEP when an individual can change his or her current plan. Some examples are:

  • If you move outside the plan's service area
  • If you are enrolled in both Medicare and Medicaid
  • If you qualify for low-income subsidy
  • If you lose creditable drug coverage from your employer
  • If your plan is no longer offered
  • If your plan is terminated by Medicare

What is Medicare Part C coverage for inpatient and outpatient care?

If you purchase Part C through a private insurer, you’ll receive coverage for any inpatient or outpatient care. 

Dropping or changing a plan. Known as the Medicare Advantage Open Enrollment Period (OEP), these three months are when you can change to a different Medicare Advantage or MAPD plan or just return to back to Original Medicare. Be careful, though, as you must be previously enrolled in an Advantage or MADP plan to even make changes during this time period. 

IEP, AEP and SEP are all perfect times to enroll in Medicare Advantage if you feel ready. 

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