Medicare Part C is not a separate benefit. Part C is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage plans.
Medicare Advantage (MA) is a United States health insurance program of managed health care (preferred provider organization (PPO) or health maintenance organization (HMO)) that serves as a substitute for “Original Medicare” Parts A and B Medicare benefits.
Medicare Part A provides payments for in-patient hospital services, excluding those of physicians and surgeons. Part B provides payments to physicians and surgeons, as well as for medically necessary outpatient hospital services (such as ER, laboratory, X-rays and diagnostic tests) and certain durable medical equipment and supplies.
Original Medicare claims payments are processed through the Centers for Medicare and Medicaid Services (“CMS”). In contrast, Medicare Advantage is offered by commercial insurance companies, who receive compensation from the federal government, to provide all Part A and B benefits to enrollees, but do not process claims through the CMS.
Most Medicare Advantage plans include the Part D prescription drug benefit plan, and are known as a Medicare Advantage Prescription Drug plan or “MAPD.” The federal government makes separate payments to plans for providing Part D benefits.
For people who choose to enroll in a Medicare Advantage plan, Medicare pays the private health plan a set amount every month for each member.
The Affordable Care Act says that your insurance company will get a bonus if they improve your Part C plan, so your coverage may change from year to year.
Many Medicare Advantage plans are also reducing the size of their provider and pharmacy networks. Or they may increase what you pay in copays or coinsurance. That’s why it’s important to shop for plans each year during the Annual Election Period. Given on-going changes to plan details, it’s a good idea to make sure the coverage you have now continues to be the best one for you.
This article is for informational purposes only and is not a complete summary of information needed to recommend any investment. Consult the appropriate professional to determine how this information applies to your unique situation.
About the Author: Charles Marsala is a Financial Advisor with Benchmark Investment Group with Securities offered through LPL Financial, a member FINRA/SIPC. He can be contacted at Charles.Marsala@lpl.com