Part C Supplement to Medicare Coverage

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It is best to take one section at a time when it comes to Medicare coverage. It can be overwhelming and confusing. Part C is explained here.

Part C is also called the Medicare Advantage Plan and is much like an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization).

Medicare Part C basically combines both Part A and Part B and is available through private insurance companies. As such, it must cover all medically needed services, and in most cases usually offers additional benefits and prescription drug coverage (Part D). It is to your advantage to shop for Part C. Different companies offer different plans with certain incentives or options to get you to purchase their plan. If you search "compare Part C Medicare plans" you will have a number of options offered by which you can make a much more informed decision.

So, what Part C (Medicare Advantage) Plans are out there? There are several and include the following:

PPO-Medicare Preferred Provider Organization - In a PPO you have the freedom to choose or doctor or specialist. If your preferred provider is not in the PPO network, there is an 'out of network' charge and your care will be more expensive. The upside is that you can usually see a specialist without a referral. HMO-Medicare Health Maintenance Organizations - You can only choose from medical providers within the HMO network, and that may include the hospital(s) you are authorized to use. This is especially important to remember in the event of an emergency and transport by ambulance. Most ambulance companies will take you to the nearest hospital, but if you are stable enough, you can request transportation to your hospital of choice or the one covered under your HMO. You will also most likely be required to have a referral from your Primary Care Physician (PCP) in order to see a specialist. PFFS-Medicare Private Fee-for-Service - In this plan you are able to see any doctor or specialist that you choose, without a referral. The only caveat is that your choice be willing to accept the PFFS's terms and conditions. It is a simple matter of asking the provider's office and of possibly obtaining that agreement in writing for your financial protection. Watch the small print on the insurance forms you fill out and ask the office personnel if you are asked to sign anything that says that you will be responsible for anything not paid by your insurance. MSA-Medicare Medical Savings Account - There are two parts to this plan. The first is a high-deductible plan that will not provide coverage until that deductible is met and the second is a savings account managed by Medicare and into which money is deposited for you to use for health care costs. Medicare Special Needs - These types of plans are for persons with specific chronic diseases or other special health needs. Any Special Needs plan must include Part A, Part B and Part D.

When it comes to prescription drug coverage most Medicare Part C plans have it included. If it is included you must take it. If you already have a standalone prescription plan and your Part C also has one, then you cannot keep your Part C coverage or must do away with the standalone prescription plan. You may want to just subscribe to Part A and/or Part B and keep your current prescription plan.

Medicare takes some time to understand, but the best approach is just straight forward. Don't hesitate to ask questions. Most Medicare representatives are more than happy to explain benefits to you and to help you choose a plan. Don't settle either! Ask questions until you understand. Do not be embarrassed at your inability to understand when it is first explained to you. Medicare is a government agency and therefore tends to talk in 'government speak'. You are not alone and if you are speaking with a representative that doesn't seem to be helping you, then find another representative. It is your right.

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