Michael M Insurance Blog

What is Medicare Part C?

Apr 13, 2021 | 0 comments

Medicare Part C is actually a Health Insurance Plan to go with Original Medicare.

Medicare Advantage plans came into existence in 1997. Like Medicare Medigap plans, they offer coverage to help lower the cost sharing associated with Original Medicare. Unlike Medigap plans, they offer plans with little or no premium but they also come with higher cost sharing when utilizing Medicare covered services. Which means there are copays for pretty much everything you do. Medicare Advantage Plans mirror the Health Insurance Plans we’ve used our whole lives. Unlike Medicare Supplement/Medigap plans, some Medicare Advantage plans come with a Part D Prescription Drug plan coverage included.


The 4 most popular types of Medicare Advantage Plan are-
HMO- Health Management Organization– This type of plan was the first type of Medicare Advantage Plan to be used. The term “Health Management” refers to coordinated care by a Primary Care Physician (PCP). This means that your Primary Care Doctor is involved with all aspects of care including visits to a Specialist which prompted the requirement of a referral. Also, HMO’s have a set Doctor/Hospital network that Medicare Beneficiaries have to stay in or pay the Full Cost(Medicare Rates) of the visit. Recently, HMO plans have eliminated the referral requirement but the need to stay in the network remains. Most plans still require choosing a Primary Care Physician prior to enrollment.
PPO- Preferred Provider Organization– PPOs were developed as an alternative to HMO’s to provide more flexibility. Medicare Beneficiaries can go in and out of the plan network but incur a higher cost when going out. A “Preferred Provider ” is an “In-Network” provider which will come with a lower cost than an out of network provider. This applies to Hospitals, labs and any other Medicare covered services. When using an out of network provider a Beneficiary may have to pay the full cost (Medicare Rate) to the provider and get reimbursed by the Insurance Carrier up to the out of network copay.
DSNP-Dual Special Needs Plans-  Plans that are available to individuals that are enrolled in both Medicare and Medicaid
CSNP- Chronic Special Needs Plan– Plans that are available to individuals with specific Chronic conditions.

Additional Benefits-

Medicare Advantage Plans also offer services over and above Original Medicare. Many plans offer services such as-
Dental Coverage
Vision Coverage
Hearing Aids
Gym Memberships
TeleHealth Services
Over The Counter Cards

Frequently Asked Questions 

Yes, some are larger than others. Care should be taken when choosing one.

Yes, most have a Part D Rx Plan embedded in them.

No, some have more comprehensive coverage than others.

Mike Miligi- Owner- Michael M Insurance Services

For over 10 years Mike has been assisting Seniors and other Medicare eligible individuals understand the ins and outs of Medicare and Medicare Health Insurance options including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD) and Dental and Vision programs.

Mike is Licensed in 7 States and Certified with 11 Insurance Carriers and has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client not the Insurance Carriers and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments and keeps abreast of industry trends and standards to offer his clients the most up to date information available.

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