Medicare Part C is also known as Medicare Advantage and those plans are sold by private insurance companies certified by Medicare. If you choose to join a Medicare Advantage plan, it becomes your primary source of coverage, instead of Original Medicare.
Also, Part C can offer additional coverage, such as vision, hearing, dental, health, and wellness programs. Most Medicare Advantage plans also include Medicare prescription drug coverage benefits, known as Part D.
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage plans.
Even though companies must follow the rules set by Medicare each plan can charge different out-of-pocket costs and can have different rules for how you get services.
Since Part C must cover the same basic services as Original Medicare (Parts A and B) the coverage of those plans includes inpatient and outpatient care.
It must provide beneficiaries with hospital and medical services as well as skilled nursing facility services and home facility care. However, hospice care stays under Original Medicare.
Medicare Advantage plans cover the same benefits for outpatient services as Part B which includes doctor visits, tests, x-rays, ambulance services, mental health services, durable medical equipment, etc.
However are a few extra benefits that Medicare Part C covers, but Original Medicare does not.
Some of the services that Part C may include as extra benefits are: Routine dental, vision, and hearing care (including x-rays, dentures, contacts and eyeglasses, and hearing aids), Fitness benefits such as exercise class or something alike (SilverSneakers membership), emergency medical assistance while outside the U.S. And allowance to buy health care products.
But not all Medicare Part C plans cover these extra benefits, as well as they are not limited to only named possible benefits.
Some of the Medicare Advantage plans beneficiaries may purchase are:
- High Maintenance Organization (HMO): with this plan you always need to stay within the provider’s network because there is no coverage for going to doctors and hospitals out of network. Also, you need to pick your primary care physician who will coordinate your every medical need. This means that you will also need a referral to see specialists.
- Preferred Provider Organization (PPO): with this plan, you don’t need to choose a PCP nor do you need to stay in the PPO’s network of doctors. However, you will pay extra if you seek out-of-network services so it is recommended that you stay in network. You also don’t need referrals to see specialists.
- Special Needs Plans (SPN): these plans serve beneficiaries with unique medical needs (chronic conditions like heart disease etc.) This plan is required to include a prescription drug plan as part of it.