What does Medicare Part C cover?

Medicare Advantage plans include all of your benefits from Part A and Part B while usually including prescription drug coverage (Part D) as well. In addition to that coverage, your plan may offer additional benefits not covered by original medicare.

Medicare

Medicare

Medicare is:

A federal health insurance program for eligible U.S.

citizens and legal residents

Funded in part by taxes you pay while working
Individual health insurance

Who Is Eligible for Medicare?
Someone who is:
A U.S. citizen or legal resident for at least 5 consecutive
years

And is one of the following:

Age 65 or older
Younger than 65 with a qualifying disability
Any age with a diagnosis of end-stage renal

disease or ALS

Medicare Supplements

Because Original Medicare coverage (Part A and Part B) has limitations, many people purchase supplemental insurance policies that are specifically designed to cover some of the gaps. These supplemental insurance policies, called “Medigap” or sometimes referred to as “Medicare Supplement” policies, are sold by private health insurance companies, not the federal government.

In most states, there are up to 10 standardized insurance plans called Medicare Supplements or Medigap plans that are lettered A through N. The insurance companies selling these plans are required by law to provide standardized coverage — meaning they have to offer the same benefits — so, the only difference between one company’s plan and another of the same letter is price. Medigap plans offer additional benefits that original Medicare do not, such as: Medicare Part A deductible Part B excess charges Part B preventative care Skilled nursing facility care coinsurance Foreign travel emergency care (up to plan limits) First three pints of blood of a transfusion (per calendar year) Some plans purchased before January 1, 2020 cover Medicare Part B’s deductible, but are being phased out.

You become eligible to enroll in a Medigap plan the first day of the month you are both age 65 or older and enrolled in Medicare Part B. Initial open enrollment lasts for six months after you first are enrolled in Part B. In most states, this is the best time to apply for a supplement because it is the only time you can receive guaranteed coverage and not be denied for having pre-existing conditions. You can apply after this date, but you may be denied coverage or charged a higher premium based on your condition. In some states, there are multiple times of open enrollment in which you can receive guaranteed coverage. Be sure to speak to a licensed Medicare agent to get state-specific Medicare information.

Even though insurance companies are required to offer the same basic benefits for plans of the same letter, they are allowed to charge different premiums. There are multiple ways they can price their premiums such as issue-age (based on the age you first enroll in the policy) and attained-age (based on the age you first bought the policy, but increases as you get older). Just know that no matter what method the company uses, premiums can increase over time for reasons other than age.

These plans don’t actually cover specific health benefits. Medigap covers the costs you’re responsible for with original Medicare. Costs covered can include: Medicare deductibles Coinsurance Hospital costs after you run out of Medicare-covered days Skilled nursing facility care after you run out of Medicare-covered days Foreign travel emergency care First three pints of blood of a transfusion (per calendar year) This is how the plan operates: You pay a monthly premium for your Medigap plan. Then, when you go to the doctor, your plan pays for the applicable Medicare costs left over by original Medicare. Depending on your plan, you could have a couple of insurance cards that you will present at time of billing. There are no network rules associated with Medicare Supplements. You can see any doctor that accepts Medicare.

Starting January 1, 2020, Medigap plans sold to new Medicare beneficiaries aren’t allowed to cover the Part B deductible. Therefore, plans C and F are no longer available. If you already have either of these two plans, you can keep them. Here is what a supplement plan G will cover: Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Part B coinsurance or copayment First three pints of blood of a transfusion (per calendar year) Part A hospice care coinsurance or copayment Skilled nursing facility care coinsurance Part A deductible Part B excess charge Foreign travel emergency care (up to plan limits) However, there are other plans that lower coverage amounts but introduce out-of-pocket limits. To ensure you have proper coverage amounts for an affordable premium, you should talk to a licensed Medicare insurance agent.

Medicare Advantage
plans

Medicare Advantage plans are a type of health plan offered through private insurance companies that contract with Medicare to provide all your Part A and Part B benefits as well as additional benefits not included with Original Medicare.
You must be enrolled in Original Medicare to qualify for this plan, also known as Medicare Part C, as it is not a replacement.

Eligibility is simple. In most cases, if you have Medicare Part A and Part B, you are eligible for an Advantage plan. The only catch is you must live in the service area.

MA plans are essentially all-in-one health coverage plans offered by insurance companies that are approved by Medicare. When you enroll in a Medicare Advantage plan, Medicare actually pays a fixed amount for your care every month to the insurance company offering the Medicare Advantage. Medicare Advantage plans are considered managed care and have networks of contracted health care providers. You may have to select a primary care physician who helps manage your care. If your plan includes prescription drug coverage, you may also receive medication management. This coordination surrounding your health care is very convenient.

Some Part C plans have a premium and some may not. One way to find out if your Medicare Advantage plan has a premium is by calling a licensed Medicare insurance agent. Other important information to know to determine your costs associated with a Part C plan is: Whether the plan pays any of your Part B premium What the yearly deductible is or if there are any other deductibles How much copay or coinsurance is The limit on your out-of-pocket costs for all medical services It’s also important to remember that each year, plans can change the amount they charge for premiums, deductibles, and other services. What you pay can change only once per year on January 1. You will receive an annual notice of change that details any changes in coverage, costs, or the service area in which your policy is effective.

You can only enroll in an Advantage plan during certain periods: Initial coverage election period — You can enroll when you first become eligible for Medicare. Your initial coverage election period is a seven-month period that start three months before the month you turn 65 and ends three months after the month you turn 65. If you are under age 65 and you receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that pertains to you, you can enroll into a Medicare Part C plan three months before your month of eligibility until three months after your eligibility. Annual election period — Also known as open enrollment, the annual election period for Medicare Advantage is October 15 through December 7 every year. Coverage for the plan you choose during this time will begin January 1 the next year. During this time, you can also add, change, or drop current coverage. Medicare Advantage Open Enrollment Period — If you enroll in a Medicare Advantage plan but decide you want to switch back to original Medicare, you can do so January 1 through March 31. If your Advantage plan included Part D prescription coverage, you can enroll into a stand-alone plan during this time to replace that piece of lost coverage. Special Election Period — If you move outside your Medicare Advantage plan’s service area, qualify for extra help (such as a program that helps pay for your prescription drugs), or move into an institution (nursing home and etc.) you might qualify for a special election period. During this time you can also make changes to your Part C coverage.

Medicare Prescription
Drug Plan

Medicare Part D is an optional benefit available to every Medicare beneficiary. It is the part of Medicare that covers most outpatient prescription drugs. It is offered through private insurance companies either as a stand-alone plan or as a part of your bundled Medicare Advantage plan.
Each plan has a list of covered prescription drugs called a formulary. If a drug you need is not on the formulary, you can request an exception or file an appeal.

To get drug coverage from Medicare, you must join either a standalone Part D plan or receive it through a Medicare Advantage plan: Medicare Part D — A standalone Part D plan adds prescription drug coverage to Original Medicare, Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans. Medicare Advantage Plan — Along with all of your Part A, Part B, and extra benefits you gain through an Advantage plan, you can sometimes receive Part D prescription drug coverage through this “all-in-one” Medicare plan.

Your initial enrollment period begins three months before the month you turn 65 and continues until three months after you turn 65. If you are becoming eligible for Medicare because of a qualifying disability, your IEP begins three months before your 25th month of receiving Social Security or Railroad Retirement Board benefits and ends three months after. However, there is an annual enrollment period and special enrollment period you must also familiarize yourself with: Annual Enrollment Period — Medicare’s AEP begins October 15 and ends December 7 every year. Any changes you make during this time will typically take effect January 1 the following year. During AEP you can: Switch Medicare Advantage Plans from one that does not offer drug coverage to one that does or vice versa Join a Part D Plan Change your Part D Plan Drop your prescription drug coverage Special Enrollment Period — A Special Enrollment Period is triggered and allows you to make changes to a Part D plan if any of this applies to you: Returning to the US after living permanently outside of the US You have Medicare AND Medicaid or get Extra Help paying for your Part D plan but have never had a change Recently had a change in your Extra Help paying for your prescription drug coverage (gained, had a change in the level of, or lost Extra Help) Recently and involuntarily lost your creditable prescription drug coverage You recently gained, had a change in level of, or lost Medicaid Experiencing a change in an employer or union Belong to a Pharmacy Assistance Program provided by your state Moved outside the service area of your current plan or recently moved and this plan is a new option Your current plan is ending its contract with Medicare or vice versa You recently left a PACE program (Program of All-Inclusive Care for the Elderly) You’re moving into, live in currently, or recently moved out of a nursing home or long-term care facility You want to make a change during Medicare Advantage Open Enrollment Period You’ve been enrolled in a plan by Medicare or your state and you want to choose a different option A weather-related emergency or major disaster has affected you. Or one of the other statements here applies but you were unable to make your enrollment because of the disaster You were recently released from incarceration Recently obtained lawful presence status in the US There may be other reasons not listed above that also provide you with enrollment opportunities.

Medicare

Medicare

Medicare Part A

Medicare Part B

Medicare Supplements

What are Medicare Supplements?

Medigap Enrollment & Eligibility

Medicare Supplement insurance premium

What do Medicare Supplement plans cover?

What are the different designs for a medicare supplement plan?

Medicare Advantage
plans

How does Medicare Advantage work?

What does Medicare Part C cover?

Cost of Medicare Advantage

Enrollment Periods

Medicare Prescription
Drug Plan

How to get drug coverage

Enrollment Periods

Licensed Insurance Agency

Legal & Compliance

Contact Details

Email:
info@mybenefitshero.com

Phone Number:
773-245-3451

4707 N Milwaukee Ave Chicago, IL 60630

Medicare

Medicare

Medicare Part A

Medicare Part B

Medicare Supplements

What are Medicare Supplements?

Medigap Enrollment & Eligibility

Medicare Supplement insurance premium

What do Medicare Supplement plans cover?

What are the different designs for a medicare supplement plan?

Medicare Advantage plans

How does Medicare Advantage work?

What does Medicare Part C cover?

Cost of Medicare Advantage

Enrollment Periods

Medicare Prescription Drug Plan

How to get drug coverage

Enrollment Periods

Licensed Insurance Agency

Legal & Compliance

Contact Details

Email: info@mybenefitshero.com

Phone Number: 773-245-3451

4707 N Milwaukee Ave Chicago, IL 60630

Medicare Advantage
plans

Medicare Prescription
Drug Plan

Email:
info@mybenefitshero.com

Phone Number:
773-245-3451