What is Medicare Part C?
Medicare Part C is also called Medicare Advantage. It is an alternative to Original Medicare (Parts A and B).
Medicare Advantage plans are offered by private insurance companies contracted by Medicare. You must be enrolled in both Part A and Part B to join a Medicare Advantage plan. You remain enrolled in Medicare Parts A and B, but you receive your benefits through the plan instead of through Original Medicare.
Understanding Medicare Advantage Plans (Part C)
Learn how Medicare Advantage plans offer hospital and medical coverage along with additional benefits that you don't get with Original Medicare, for example, vision, hearing and prescription drug coverage.
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What’s covered by Medicare Advantage?
By law, Medicare Advantage plans must provide at least the same coverage that’s offered by
Original Medicare Parts A and B. Beyond what’s required, plans may include a variety of additional benefits. In general, Medicare Advantage plans help pay for the following services —all combined in a single plan.
All benefits of Part A, except hospice care
Skilled nursing care Nursing care that should be provided only by a licensed nurse.
Home health care In Original Medicare, skilled nursing care and therapy, such as speech therapy or physical therapy, provided on a part-time or intermittent basis to those who cannot leave the home.
All benefits of Part B
Prescription drug coverage is included in many
Medicare Advantage plans, but not all
Extras may be bundled with the plan
What’s not covered by Medicare Advantage?
Medicare Advantage plans do not help with the cost of:
- Hospice care. Original Medicare Part A pays for hospice care even when you get your benefits through a private Medicare Advantage plan. The Medicare Advantage plan would continue to cover health care services not related to the hospice care.
- All of the prescription drugs that might be covered under a standalone Medicare prescription drug plan. Each plan has a formulary that lists the drugs it covers.
What are the coverage limits with Medicare Advantage?
Each Medicare Advantage plan sets its own coverage terms and limits. It’s important to carefully review the terms and limits of any plans you are interested in.
What providers can you see with Medicare Advantage?
There are different types of Medicare Advantage plans. Each type has its own terms about what providers A person or organization that provides medical services and products, such as a doctor, hospital, pharmacy, laboratory or outpatient clinic. you can see.
With Medicare Advantage coordinated care In Medicare Advantage (Part C), this refers to a kind of health care plan that links providers and services to deliver efficient, cost-effective patient care. Plan members usually have to use doctors and hospitals that are within the plan’s network. These plans are also referred to as “managed care plans.” plans, you choose a primary care doctor who can help manage your care. In some plans, your doctor must refer you to other providers or specialists if you need special care.
With some coordinated care plans, you must get your care and services from network The group of health care providers, such as hospitals, doctors and pharmacies, that agrees to provide care to the members of a Medicare Advantage coordinated care plan or Medicare Part D prescription drug plan. These providers are called “network providers” and “network pharmacies.” providers. Otherwise, you may have to pay the entire cost for services you receive outside the network. With other plans, you may access providers outside the network, generally at a higher cost. Each plan has its own network.
Certain types of Medicare Advantage plans allow you to see any Medicare-eligible provider who accepts the terms, conditions and payment rates of the plan. These plans often require providers to give their acceptance each and every time before they deliver any care or services.
All Medicare Advantage plans provide nationwide coverage for emergency care, urgent care and renal dialysis.
What is a service area?
Each Medicare Advantage plan has a service area. This is a geographic area where the plan is available and offers coverage. A service area is usually a county, state or region. You must live in a plan’s service area in order to enroll in that plan.
You may have many Medicare Advantage plans to choose from, and each plan is different. It’s important to look carefully at the specific benefits offered by plans you are considering.