Medicare Part C

Part C

Part C is another name for Medicare Advantage.  They are offered through private insurance companies that are under contract and regulated by the Centers for Medicare and Medicaid Services (CMS).  You have a choice to enroll in a Medicare Advantage Plan as an alternative to Original Medicare. Rest assured, you remain in the Medicare system and have all the same rights and protections. 

Medicare Advantage plans have a network of providers. It is a list of providers (doctors, hospitals, labs, etc.) that a plan has contracted with to provide health care to its members.  Each insurance company will have a different network of providers.

There are Different Types of Medicare Advantage Plans

In Washington state, the three most common types of plans are:

1. Health Maintenance Organizations / HMO
HMOs are managed care plans.  That means your healthcare will be managed, or coordinated by your contracted, or “in-network" Primary Care Physician (PCP).  A referral is required from your PCP to see an “in-network” specialist.  You can only use “in-network” providers unless there is an emergency.
 
2. Preferred Provider Organizations / PPO
Similar to HMOs, PPOs have “in-network” and “out-of-network” providers.  If you use in-network providers, you will pay less for covered services.  If you use “out-of-network” providers, you normally will pay higher co-pays, coinsurance, or deductibles.  Referrals are generally not required to see a specialist.
 
3. Special Needs Plans / SNP
​SNPs are plans limited to people with specific diseases or chronic medical conditions and are “dual eligible”, receive both Medicare and Medicaid. 

What does Part C cost and what does it cover? 

It depends on the plan you choose. They range in price starting with zero premium plans and there are a wide selection of plans with varying benefits, copayments, and maximum out of pocket amounts.  Plus, many offer extra benefits such as vision, hearing, preventive dental, acupuncture, and fitness memberships. 

Did you know?

To be eligible for a Medicare Advantage Plan, you must...
  • Be a permanent resident in the plan’s service area
  • Be enrolled in Parts A & B 
  • Continue to pay your Part B premium
  • Use the plan’s network of contracted providers to receive the best benefit
Insurance companies offering Medicare Advantage Plans...
  • Must offer at least the same benefits as Original Medicare Part A and Part B 
  • Must follow rules and regulations set by Medicare
  • May change the plan’s benefits and rates each year 
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