Medicare Part C

  • Medicare Advantage plans.
  • Like an HMO or PPO.
  • Covers all Part A and Part B services.
  • Extra coverage like vision, hearing, dental, gym membership, and other health and wellness programs.
  • Usually includes prescription drug coverage (Part D).
  • $0 monthly premiums available.

What Are The Different Types of Medicare Advantage plan?

  • Health Maintenance Organization (HMO) plans - In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan's network except in an urgent or emergency situation. You may also need to get a referral from your primary care physician  for tests or to see other doctors or specialists.
  • Preferred Provider Organization (PPO) plans - In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong in the plan's network. You can also use out-of-network providers for covered services but usually at a higher cost. Most plans don't require referrals to see a specialist and you don't need to choose a primary care physician.
  • Private Fee-for-Service (PFFS) plan - PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan's payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
  • Special Needs Plan (SNP) - SNPs provide focused and specialized health care for specific groups like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions such as diabetes, cardiovascular disease.
  • Medical Savings Account (MSA) - Similar to Health Savings Accounts outside of Medicare. Combines a high deductible insurance plan with a medical savings account that you can use to pay for your health care costs. You can choose your healthcare services and providers.

What Else Should I Know About Medicare Advantage Plans?

  • You have Medicare rights and protections, including the right to appeal.
  • You can check with the plan before you get a service to find out if it's covered and what your costs may be.
  • You must follow plan rules. It's important to check with the plan for information about your rights and responsibilities.
  • If you go to a doctor, other health care provider, facility, or supplier that doesn't belong to the plan's network, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.
  • Providers can join or leave a plan's provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.
  • If you join a clinical research study, some costs may be covered by Original Medicare and some may be covered by your Medicare Advantage plan.
  • Medicare Advantage plans can't charge more than Original Medicare for certain services, like chemotherapy, dialysis, and skilled nursing facility care.
  • Medicare Advantage plans have  a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you'll pay nothing for covered services. This limit may be different between plans and can change each year.