Medicare Part C – General Coverage Information
Medicare Part C, also known as Medicare Advantage, is a health care coverage option you can choose when you are eligible for Medicare Part A and Part B. Medicare Advantage is a type of health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. As with Original Medicare, enrollees in an MA plan can join a plan even if you have a pre-existing condition (except for ESRD). You will still have the same rights and protections as you would under Original Medicare, including the right to appeal decisions made regarding your care.
There are several types of MA plans to choose from, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) Plans, Special Needs Plans (SNPs), HMO Point of Service Plans, and Medicare Medical Savings Account (MSA) Plans. If you enroll in a Medicare Advantage Plan, your Medicare services and supplies will be covered through the plan and will not be paid for by Original Medicare. MA plans must offer the same benefits as Original Medicare, but many of them offer additional benefits, including, but not limited to, vision care, dental care, hearing exams and many offer prescription drug coverage (Part D).
Medicare pays a fixed amount to these companies that offer MA plans, and they must follow rules set by the federal government. These companies can vary in costs and services, though, so it is important to compare plans available in your area. Most MA plans require their members to use their network of physicians, hospitals, providers, and pharmacies. If you choose to go out of network, you may have to pay higher costs. If you choose a Medicare Advantage plan with prescription drug coverage (an MA-PD), you should consider that each plan my have a different formulary, or list of covered drugs, and may have different tiers, or levels, of pricing for the covered medications.