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Medicare Part C

What Medicare Part C covers?

Medicare Part C is also referred to as Medicare Advantage. These plans are provided by private insurance companies as alternative to coverage managed by the Federal Government. The plans while offered by private insurance companies are contracted by the Federal Government and have guidelines the must follow. 

Medicare Advantage plans will provide all of the Medicare Part A and B services. 

Majority of the Medicare Advantage plans will also provide extra coverage that Original Medicare does not provide such as:

Dental coverage

Vision coverage

Hearing coverage

Prescription coverage

Over-the Counter benefits

Gym memberships

Food cards

and more coverage.

Every plan is going to provide  different extra benefits, so you should ensure that you talk with a local expert to ensure you get the proper information about the plan details and that it fits your needs.

AIS Medicare & More agents specialize in Medicare insurance and are going to work to ensure that the plan you choose is the option that meets your health and financial needs

Who Qualifies for Medicare Part C

Anyone that has Medicare Part A and Part B qualifies to get a Medicare Part C (Medicare Advantage) plan. You must keep your Medicare Part A active and you must continue to pay your Medicare Part B premium to qualify for a Medicare Advantage plan. 

Dropping Part A or B will cause your Medicare Advantage plan to cancel.

How Much does Medicare Part C cost

Medicare Advantage plans can start at $0 a month (you must keep Part A and B active and pay those premiums, if any). 
When you are looking in Medicare Advantage plans and see that they are $0, that may raise some questions.. The reason the companies are able to offer $0 monthly premiums is because they get paid by the Federal Government to manage your healthcare. There are also plans that have premiums, some plans with premiums will offer higher benefits, lower copays, lower out of pocket expenses, or allow you more freedom of how you can use the plan. However, the many $0 plans will offer high benefits and low costs as well, this is another reason you want to ensure that you sit down to look over all of the options available in your area.

Medicare Advantage plans will come with some out of pocket costs to be aware of as well:

Deductibles: A deductible is the amount of money you must pay out of pocket before the insurance company pays anything. A Medicare Advantage plan can have a deductible on your Medical expense and/or your Prescription coverage. Many plans do not have deductibles on either though.

Copays: A copay is a fixed dollar amount you must pay for a service, the insurance company will then pay the rest of the expenses for that service.

Coinsurance: A coinsurance is a percentage of the cost you must pay for a service, the insurance company will then pay the rest of the expenses for that service.

Types of Medicare Advantage Plans (Part C)

Medicare Part C plans can be broken down into a couple different types, which can offer different benefits, networks and costs.

Health Maintenance Organization (HMO)

A Health Maintenance Organization, is a type of Medicare Advantage plan that requires you to use 'in-network' providers unless it is an emergency situation. Each carrier will have their own network of providers, so when choosing your plan you should always ensure that your doctors are in the network. Typically, you can only access non-emergency or general care in your plans  service area which may be limited to specific counties within your State. You will pay 100% of Out-of-Pocket expenses if you use providers not in the network.

Preferred Provider Organization (PPO)

A Preferred Provider Organization, is a type of Medicare Advantage plan that allows you to see providers in and out of the network. The providers that are 'in-network' will be less expensive to use and will typically be billed with copays.
'Out-of-Network' providers will be more expensive and will typically be billed on a coinsurance basis. PPO plans may also have a larger service area allowing you to go to other states with 'in-network' coverage. 

Private Fee For Service (PFFS)

Private-Fee-For-Service, is a type of Medicare Advantage plan that allows you to see providers that agree to accept the plans terms and conditions. This requires you to call the doctors office before services are provided  to ensure coverage is still available. This must be done EVERY time before an appointment. These plans give you the freedom to see any doctor willing to accept the terms and conditions, but can also be disruptive if the doctor decides tp stop accepting the plan. 

Special Needs Plan (SNP)

Special Needs Plan, is a type of Medicare Advantage plan that are tailored for certain groups of beneficiaries. The types are:

Dual-Eligible (D-SNP):

These types of Special Needs plans are for those that qualify for both Medicare and Medicaid. 

Chronic Condition (C-SNP):

These types of Special Needs plans are for those that have a qualifying chronic condition and Medicare.

Institutional (I-SNP):

These types of Special Needs plans are for those that are admitted to an institution for 90 or more days.

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