Medicare Part C or Medicare Advantage Plans

By: Taylor


Congress created Medicare in 1965 under Title XVIII of the Social Security Act. Medicare, at its inception was to provide health insurance coverage to any United States citizen over the age of 65, regardless of their medical history or income level. At that time, only half of older adults in the United States had health insurance and the other half found it unavailable, due to preexisting medical conditions, or insurance was just not affordable on their limited income.

Medicare Part C History

When the Balanced Budget Act of 1997 passed, Medicare beneficiaries were given the option to receive their benefits through private health insurance plans. These plans were known as Medicare+Choice or Part C plans. In 2003 with the Medicare Modernization Act, Part C was made more attractive to beneficiaries when the prescription drug coverage was added and Medicare+Choice was renamed the Medicare Advantage Plan.

Medicare Part C Coverage

Part C – The Medicare Advantage Plan are health plans offered through a private insurance company that is under contract with Medicare, and provide you with all the benefits normally covered under Medicare Part A and Medicare Part B.

Coverage includes everything that is normally covered under both Medicare Part A and Medicare Part B which include Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE). Medicare Advantage Plans include Medicare Medical Savings Account Plans, Special Needs Plans, Private Fee-for-Service Plans, Preferred Provider Plans and Health Maintenance Organizations (HMO’s).

Beneficiaries enrolled in Medicare Advantage Plans have their Medicare services covered through the plan and are not paid for by the Original Medicare. Most Medicare Advantage Plans include prescription drug coverage.

Drug Coverage:

Most Medicare Advantage Plans come with a prescription drug plan (Medicare Part D). If the insurance provider you choose, does not offer a drug plan, you are free to join a Medicare Prescription Drug Plan (Part D). However, you are not allowed to have both.

Medicare Part C Costs

Your out-of-pocket costs for a Medicare Advantage Plan will depend on a variety of things including:

If the plan charges a monthly premium.
If the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
If the plan has a yearly deductible – or any additional deductibles.
How much you the plans co-pay or co-insurance payments are. For example, plans where a co-pay for a doctor’s visit is set at $10 will have a lower out-of-pocket than plans with a co-pay of $20.
What type of medical care service you need, and how often you get them.
If you go to a doctor or medical supplier who accepts assignment. For example, if you’re in a PPO, PFFS, or MSA plan and you go to an out-of-network doctor.
If you follow the plan’s rules, like using network providers.
If you require extra benefits and if the plan charges for it.
The plan’s yearly limit on your out-of-pocket costs for all medical services.
Whether you have Medicaid or get other help from your state.

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