Medicare Part C (Medicare Advantage)
Last Updated : 08/01/20194 min read
Medicare Part C is also known as the Medicare Advantage program. In this article, we describe Medicare Part C to make it easy to understand.
Medicare Part C and the other parts of Medicare
The traditional Medicare program is called Original Medicare. It’s made up of Medicare Part A and Part B.
- Medicare Part A is hospital insurance.
- Medicare Part B is medical insurance.
Many people are automatically signed up for Part A and Part B when they become eligible for Medicare. What about Medicare Part C?
- Medicare Part C, the Medicare Advantage program, gives you a way to get your Part A and Part B benefits through a private insurance company that contracts with Medicare.
- Under Medicare Part C, you get all your Part A and Part B benefits (except hospice care, which you still get through Part A).
- Most Medicare Advantage plans under Part C also include prescription drug coverage. This is something that you don’t get through Original Medicare except in certain cases (for example, in a hospital or clinic). Original Medicare doesn’t cover most medications you’d take at home.
What’s more, many Medicare Advantage plans include extra benefits, such as prescription drug coverage.
- Medicare Part D is prescription drug coverage.
- Like Medicare Advantage, Medicare Part D is available through private, Medicare-approved insurance companies.
- You can sign up for a stand-alone Medicare Part D prescription drug plan if you stay with Original Medicare (Part A and/or Part B).
- However, under Medicare Part C, some Medicare Advantage plans include this coverage as well. They are sometimes called Medicare Advantage prescription drug plans.
So you could say that Medicare Part A + Part B + Part D = Part C (although it’s not always the case). Not all Medicare Advantage plans include prescription drug coverage.
Medicare Part C: what extra benefits do some plans offer?
Besides prescription drug coverage, there are some benefits that go beyond what Medicare Part A and Part B include. Medicare Part C providers are allowed to offer certain other services, such as:
- Routine dental services
- Routine vision services
- SilverSneakers fitness program
- In-home safety reviews
- Medication “reconciliation” *
- Bathroom safety devices
- Enhanced disease management
*If a plan offers medication reconciliation, a qualified health-care provider can look at any new medications you may be taking home from a hospital stay, for example. The provider can coordinate with your doctor to compare these with medications you were already taking at home, and make sure there wouldn’t be adverse interactions between these prescription drugs. The provider can make it clear to you which medications you should now be taking, and which (if any) you should stop.
Medicare Advantage plans don’t have to offer these benefits. Coverage beyond Part A and Part B varies from plan to plan. So, be sure to think about what benefits you need and look for plans that include those benefits.
Medicare Part C: what do you need before you enroll?
There are some requirements you need to meet for Medicare Part C.
- Be enrolled in Medicare Part A and Part B
- Live within the plan’s service area
- Keep paying your monthly Medicare Part B premium, along with any premium the plan might charge.
If you have end-stage renal disease (ESRD), which is kidney failure requiring regular dialysis or a kidney transplant, you may not be eligible for most Medicare Advantage plans. You may be able to get a Medicare Special Needs Plan for people with ESRD if one is available in your area.
When can I sign up for Medicare Part C?
You generally have at least two opportunities to sign up for Medicare Part C.
- When you’re first eligible for Medicare. You can sign up during your Medicare Initial Enrollment Period.
- During the Annual Election Period, also called Fall Open Enrollment. This period runs from October 15-December 7 every year.
You might be able to enroll in a Medicare Advantage plan under Medicare Part C during other time periods. For example:
- You may be able to switch from one Medicare Advantage plan to another during the Medicare Advantage Open Enrollment Period, January 1-March 31 every year.
- If you have special circumstances, such as losing employer-based health coverage, you might qualify for a Special Election Period to sign up for a Medicare Advantage plan.
Would you like to compare Medicare Advantage plans and see if there’s one in your area that would work better for you than your current plan? All you need to do is enter your zip code in the box on this page to begin.