Part C is generally referred to as a Medicare Advantage Plan, which is when a person purchases an insurance plan from a contracted private provider to administer his or her health insurance. The purchased plan changes how someone accesses healthcare, such as through an HMO, PPO, or fee-for-service plan. This may result in different coverage levels, depending upon the specific policy that is selected.
If you have a Medicare Advantage Plan, it replaces the co-pays and co-insurances offered through the original Medicare benefits plan. Most Medicare Advantage Plans will also provide prescription-drug coverage.
If you purchase a Part C plan, it means that you lose the coverage stated for Part A (Hospital Insurance) and Part B (Medical Insurance). These are considered “traditional” or “original” Medicare. Additionally, you are only allowed to purchase a “Part D” prescription drug plan if your “Part C” plan does not offer prescription drug coverage. Part D coverage will be discussed in the supplemental policy options shown below.
How do I choose providers?
Most plans will have a network of doctors, hospitals, and ancillary healthcare providers that are covered under their policy.
What costs are associated with a Part C plan?
If you select a Part C/Medicare Advantage Plan, you will typically be charged a monthly premium by the insurance. Additionally, you will be responsible for co-payments, co-insurances, and deductibles charged for covered services under the selected plan. Out-of-pocket costs and policy coverage will vary depending upon which policy is selected.
Important things to consider when selecting a Medicare Advantage Plan:
- Medicare Advantage Plans will have lists of “in-network” and “out-of-network” physicians, whereas “original” Medicare generally covers any physician who accepts Medicare. If maintaining open access to all physicians is important to you, then you may want to be cautious about selecting a Part C plan.
- Medicare Advantage Plans like original Medicare will also have a drug formulary (a list of covered medications) and some policies may be more restrictive than others. Be sure to call the insurance provider and obtain a list of covered medications before choosing a policy.
When considering a Medicare Advantage Plan (Part C), you need to be aware of the supplemental insurance options associated with original Medicare (Parts A and B)
Part D is an optional prescription drug plan available to individuals with original Medicare. It is designed to provide outpatient drug coverage. Most Medicare Advantage plans already provide prescription drug coverage included with Part C, and when this is the case, Part D may not be purchased.
- If you purchase a Medicare Advantage Plan (Part C) with prescription-drug coverage as part of the plan, and you then choose to purchase a “Part D” prescription supplement plan, you will be dropped from your “Part C” plan and returned to a traditional Medicare plan.
- A few select Medicare Advantage Plans will not offer prescription-drug coverage. To learn more about selecting a Part D policy to supplement your Medicare Advantage plan, please see the Part D section of MSAA’s online My Health Insurance Guide.
You cannot purchase a supplemental Medigap Policy if you select a Medicare Advantage Plan. To learn about the difference between a Medigap supplemental insurance policy and a Medicare Advantage Plan (Part C), please see the explanations shown below.
What is the difference between a Medicare Advantage Plan and a Medigap insurance policy?
A Medicare Advantage Plan is an insurance plan that is purchased by an individual from a contracted private provider, who will administer his or her health insurance. The purchased plan changes how someone accesses healthcare (such as an HMO, PPO, or fee-for-service plan), which may result in different coverage levels, depending upon the specific policy that is selected.
If you have a Medicare Advantage Plan, it replaces the co-pays and co-insurances offered through the original Medicare benefits plan. Most Medicare Advantage Plans will also provide prescription-drug coverage. Please note that you cannot purchase a supplemental Medigap Policy if you select a Medicare Advantage Plan.
A Medigap policy is just a supplement to the original Medicare benefits plan (A and B) and may include increased coverage of things such as co-pays, as well as co-insurance that Medicare doesn’t cover. If a person has a Medigap policy, bills will be paid first through the original Medicare plan, and then go through the supplemental Medigap policy for additional coverage. Also, since you cannot purchase a supplemental Medigap Policy if you select a Medicare Advantage Plan, a Medigap policy cannot be used toward co-pays or co-insurance with a Medicare Advantage Plan.
For More Information
Visitors to MSAA’s online My Health Insurance Guide are invited to browse throughout the different sections for more information on the different parts of Medicare as well as other insurance options, or to view our Healthcare Insurance Glossary, online webinars and video, or our new publications.