What is Medicare Part C?

Medicare Part C is a health insurance plan with Original Medicare.

Medicare Advantage plans came into existence in 1997. Like Medicare Part C 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 include Part D Prescription Drug plan coverage.

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 a referral requirement. Also, HMOs 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 before enrollment.
PPO- Preferred Provider Organization– PPOs were developed as an alternative to HMOs 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 comes at 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 provider the full cost (Medicare Rate) 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 who 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
The Counter Cards

Frequently Asked Questions

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Mike Miligi- Owner- Michael M Insurance Services

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

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He 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.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.