The Basics of Medicare Part C

The Basics of Medicare Part C

In our last blog post, we discussed the basics of Medicare Part D. This week, we will delve into the basics of Medicare Part C, also known as Medicare Advantage.

Medicare Advantage Plans take place of Original Medicare (Parts A and B) and your Medicare Part D drug prescription plans. This means that the carrier you choose through a network of Medicare-approved providers will be your primary insurance.

Medicare will no longer pay your claims; you’ll have copayments and deductibles for all of your services; and you have to follow the network of doctors and hospitals for the carrier you chose through Part C.

Because you need to stay in network with your Medicare Advantage plan, there could be issues if you are traveling and there is not a network where you are visiting. With Original Medicare, you can go to any doctor in the country that accepts Medicare. With Medicare Advantage, plans and copays can also change year to year.

You need Medicare Parts A & B in order to enroll in Medicare Part C–and Parts A & B must stay active in order for your Medicare Part C to remain active. You do not need to enroll in Part D for prescription coverage, nor are you permitted to have a separate prescription plan, if you have Medicare Advantage. Most Medicare Part C plans include a prescription option, and so if you want prescription coverage you must choose a plan that includes this.

Unlike Original Medicare and Part D, there are no penalties if you sign up for Medicare Advantage after your initial enrollment period–which is the 3 months after you enroll in Part B. However, you cannot sign up after the initial enrollment period, unless there is a Special Enrollment Period (SEP). You can also sign up during the Annual Enrollment Period which takes place from October 15th to December 7th for plans starting January 1st.

If you signed up for Medicare Advantage but find that it doesn’t work for you, you can roll off of it within the first twelve months of the plan with a valid reason (such as: your provider left the network, or you moved out of the service area). Otherwise, you are locked into the plan for a calendar year but can change plans during the Annual Enrollment Period, where you can switch to a Medicare supplemental plan or stand-alone prescription plan.

Need more information on Medicare Advantage (Part C) plans or are looking to enroll? Contact Hafetz and Associates today at 609-872-0001 — we can help!

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