Medicare Part C Plans Overview
Medicare Part C plans, also called Medicare Advantage plans, are offered by private insurance companies as an alternative to the federal government’s Original Medicare plans. Most Original Medicare plans are basic and don’t have any extras. But Medicare Advantage plans do have extras, like dental coverage or fitness programs. Medicare is a complex subject — Benzinga will break it down so you can choose a Medicare plan with confidence.
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Best Medicare Part C Providers:
- Best Overall for Medicare Part C: Humana
- Cheapest for Medicare Part C: Aetna
- Best Coverage: Highmark
- Best for Extras: Blue Care Network
What is Medicare?
Medicare is a government-sponsored health insurance plan for seniors 65 and above. You’re eligible if you’ve paid Medicare taxes throughout your life and are a U.S. citizen. You can also enroll if you’re classified as disabled by the Social Security Administration and under 65. You have a short window of time to enroll in Medicare — 3 months before and 3 months after your 65th birthday.
There are a few exceptions to this rule. Let’s say you experience a life event like a marriage or move. You may qualify to enroll during a Special Enrollment Period. You may pay a substantial late penalty if you don’t sign up during the enrollment period.
You can’t switch plans until the Annual Election Period once you’ve enrolled in a Medicare plan, from October 15 through December 7. Let’s say you have a Medicare Advantage plan and want to switch back to Original Medicare. You can do that from January 1 through February 14. Medicare plans are divided into 4 parts:
Part A covers inpatient hospital care, skilled nursing facilities and some home care.
Part B covers outpatient care, doctor and specialist visits and medical equipment and supplies. Note: Part A and Part B combined are known as Original Medicare, the government’s plan.
Part C offers everything Part A and Part B covers, but usually includes extras such as vision and hearing coverage, fitness programs and wellness incentive plans. Part C or Medicare Advantage plans are offered by private insurers.
Part D covers prescription drugs and is also offered by private insurers. Part D plans can be purchased as standalone plans in addition to Original Medicare plans or as part of a Medicare Advantage plan.
You can also by a Medicare Supplemental Insurance plan, which is intended to fill in the gaps from an Original Medicare plan. These plans, also known as Medigap plans, are offered by private insurers.
There are 2 basic types of Medicare Advantage plans:
Health Maintenance Organization (HMO)
HMOs are networks of doctors, hospitals and specialists that you must use — you can’t choose providers out of the network. You must choose a primary care doctor who will give you a referral to see a specialist. HMO plans promote health and wellness and require you to maintain a healthy weight, watch your blood pressure and encourage you to quit smoking.
They offer fitness and weight loss programs, blood pressure medication and smoking cessation programs. HMO plans are typically cheaper than PPO plans, but they limit you to where you can go and the medical professionals you can see for care.
Preferred Provider Organization (PPO)
PPOs involve a large network (usually larger than HMOs) of doctors, specialists and hospitals you can choose for care. You’re not required to choose a primary care doctor but you’re encouraged to do so. You’ll pay less if you choose providers within the PPO. Referrals aren’t required with these plans and you can switch doctors anytime.
Providers and hospitals within PPO networks agree to charge preset amounts for services and care. You’ll pay less for prescription drugs if you choose a pharmacy on its preferred pharmacy provider list. PPO plans give you more freedom and they’re often priced higher.
Comparing Costs of Part C Plans
You can compare Medicare Advantage plans using Medicare.gov’s plan finder tool. Enter your zip code and answer a few questions and you’ll see search results for plans in your area, including price estimates.
Your results will include a star rating from the Centers for Medicare and Medicaid Services (CMS), the government agency that oversees Medicare Advantage plans. These ratings, which range from 1-5, are based on areas such as provider choice, pricing and customer satisfaction. Here are a few examples of plans we found using the tool.
|Plan Name||Company||Plan Type||Health and Drug Costs||Star Rating|
|Senior Plus Option 1||HAP||PPO||$4,490||3.5|
These rates are estimates and could vary from plan to plan, so check with the insurance company for the most accurate price.
How to Sign Up for a Medicare Advantage Plan
Just as you can compare plans on the Medicare.gov site, you can sign up for a Medicare Advantage plan there, too. It’s a one-stop-shop for everything you need to know about Medicare and plans. You can also contact individual insurance companies and talk to a licensed sales agent or customer service representative who will walk you through the enrollment process.
Legalities of Part C Plans
CMS sets guidelines and regulates what Medicare Advantage plans can offer in terms of pricing, providers and marketing practices. Insurers that violate CMS policies can be fined or have their plans suspended or terminated. You have the right to be treated fairly and have your privacy protected. You can file a claim if you feel your rights have been violated — use the “Claims and Appeal” tab on Medicare.gov.
Factors that Can Impact Medicare Plan Costs
The price you pay for a Medicare Advantage plan is impacted by several factors:
Age: You’ll require more health care services at age 75 compared to age 65.
Income: Depending on your income, you might have to pay a $100–$300 surcharge called an Income-Related Monthly Adjustment Amount (IRMAA).
Cost of living: Medicare Advantage plans go up in price as the cost of living increases.
Health status: You could pay more if you smoke, have high blood pressure or are overweight — unless you take measures to improve your health.
Location: Plans vary from state to state, so if you live in California you could pay higher premiums than if you live in Michigan.
Most of these factors are out of your control but you may be able to lock in lower premiums if you buy a Medigap plan, so check with insurance providers.
Best Medicare Part C Insurance Providers
We’ve read reviews from sources such as J.D. Power and Associates, Medicare.gov and the Kaiser Family Foundation to evaluate our top picks for Medicare Advantage plan providers.
1. Best Overall Medicare Provider: Humana
Most of Humana’s Medicare Advantage plans have above-average star ratings. The company also ranks high in J.D. Power and Associate’s annual Medicare Advantage study.
The study rates plans for overall satisfaction, billing, customer service, cost, coverage and benefits, provider choice and customer satisfaction.
2. Cheapest Medicare Provider: Aetna
Aetna offers affordable HMO and PPO plans in all 50 states and also offers plans with monthly premiums as low as $0, with affordable copays and deductibles.
It’s a top-rated plan with high rankings in J.D. Power and Associate’s studies.
3. Best Coverage for Medicare Provider: Highmark
Highmark received top honors for provider choice in the J.D. Power and Associates study. Highmark’s website features a Find a Provider tool so you can easily search for doctors and specialists in your area.
Choose a Medicare Advantage plan that offers a large network of providers so you can continue to see the doctors you trust.
4. Best for Extras: Blue Care Network
Blue Care Network’s Medicare Advantage plans offer optional coverage for hearing, dental and vision for less than $25 more a month. It also features free fitness programs in every state.
Blue Care Network’s plans are top-ranked by J.D. Power and Associates and many of its plans have above-average star ratings. Blue Care Network just might have a plan for you.
Compare and Shop Around
Enrollment in Medicare Advantage plans has doubled in the past decade, from 10.5 million to 22 million enrollees, according to the Kaiser Family Foundation. This kind of growth promotes competition among private insurers to bring you better rates and features. You wouldn’t even think of buying a new car or house without thorough research before you make a decision. The same holds true when you choose a Medicare Advantage plan.
You have plenty of resources to help you find the right plan — Medicare.gov, CMS.gov and other credible sites. Take your time, read the reviews and talk to friends and family members about the plans they have before you make a choice that will impact your health and well being for the rest of your life.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.