What does Medicare Part C Cover?

Medicare Part C, also known as Medicare Advantage, offers privately provided Medicare plans that act as substitutes for traditional Medicare coverage. Similar to group insurance benefits you may have had through previous employers, Part C plans typically include a local network of healthcare providers. With Medicare Part C, you’ll pay copays for routine services such as doctor’s visits, lab work, ambulance services, surgeries, hospital stays, and urgent care.

Medicare Part C provides coverage for the same services as Part A and Part B, encompassing both hospital and outpatient benefits. However, instead of paying deductibles and 20% of medical services as with traditional Medicare, you’ll pay copays according to the plan’s structure.

Now widely recognized as Medicare Advantage, Part C combines Part A, Part B, and often Part D into a comprehensive package. This means you’ll have one ID card that you can use at hospitals, doctor’s offices, and pharmacies. Most Advantage plans include an integrated Part D drug plan, although some options without Part D coverage may be available in certain areas.

Enrolling in Medicare Part C:

Enrollment in Medicare Part C, or Medicare Advantage, differs from the enrollment process at the Social Security Administration. Medicare Part C plans serve as an optional alternative to traditional Medicare, and not everyone needs to enroll in Part C.

You can enroll in a Medicare Advantage plan when you first become eligible for Medicare Part B. Additionally, you have the opportunity to enroll during the annual election period, which takes place from October 15 to December 7 each year. Coverage under the selected plan begins on January 1.

Who is Eligible for Medicare Part C?

To be eligible for Medicare Part C, or Medicare Advantage, you must first be enrolled in both Medicare Part A and Part B, and you must reside within the service area of the plan. Medicare Part C allows you to receive your benefits through a private insurance company instead of Original Medicare.

Eligibility for Medicare Part C applies to all Medicare beneficiaries, regardless of age, as long as the following criteria are met:

Enrollment in both Medicare Part A and Part B: It’s important to note that attempting to drop Part B after enrolling in Part C will result in immediate termination of your Part C plan.
Residing within the plan’s service area: Medicare Part C eligibility is based on the address you have on file with Social Security. You must select a plan that operates within the same county. Some plans are limited to specific counties, while others cover the entire state.
Absence of End-Stage Renal Disease (ESRD): The eligibility for Medicare Part C involves answering medical questions, and ESRD is typically a disqualifying condition.

Remember, Medicare Advantage plans have specific election periods, allowing enrollment only during the Initial Enrollment Period or the Annual Election Period in the fall. Certain Special Election Periods (SEPs) may also apply in particular circumstances, such as relocating out of state and losing your plan.

Gain further understanding about Medicare Part C and explore your options during the designated enrollment periods to make informed decisions about your healthcare coverage.

Medicare Special Needs Plans

What does Medicare Part C Cover?

Enrolling in Medicare Part C:

Who is Eligible for Medicare Part C?

Eligibility for Medicare Part C applies to all Medicare beneficiaries, regardless of age, as long as the following criteria are met:

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