Medicare Part C Plans
Medicare Part C plans, also known as Medicare Advantage plans, were established by the Medicare Modernization Act of 2003 (MMA) to replace the Medicare+Choice (M+C) program. The M+C program was created in 1998 as a method of saving the Medicare program money. However, the issue with this program was that beneficiaries in rural areas and smaller towns did not have many different options. The MMA aimed to provide more options for all beneficiaries, so they created new types of Medicare Part C plans. Today, these plans are not aimed to save the Medicare program money but to offer alternative private health plans to beneficiaries across the nation.
Medicare Part C plans provide the same benefits as Original Medicare (Part A and Part B) and may offer additional benefits such as vision, dental, and prescription drug coverage. These plans are provided by private insurance companies, so cost and availability may differ by location. Costs associated with Medicare Part C plans include monthly premiums, annual deductibles, coinsurance, and copayments.
There are a variety of Medicare Part C plans available for Medicare beneficiaries, including the following:
- Health Maintenance Organization (HMO): These plans require that you see doctors and go to pharmacies and other health care providers in the plan's network. They may also require that you get a referral from a primary care physician to see a specialist.
- Preferred Provider Organization (PPO) : These plans pay for more of the costs of health care services and supplies if you use its network doctors and health care providers. You may pay more out-of-pocket if you choose to use a provider outside of the plan's network.
- Private Fee-for-Service (PFFS) : These plans determine how much they will pay doctors and health care providers on a situational basis. This, in turn, also determines how much beneficiaries will pay out-of-pocket when they receive care.
- Special Needs Plan (SNP) : These plans are limited to people with certain conditions or diseases, and provide benefits suitable for those individuals.
Each Medicare Part C plan may provide different coverage at different costs depending on the private insurance company offering it. Plans may change the costs of premiums, services, and deductibles on an annual basis, so it is recommended that beneficiaries review their plan each year to be sure that they are enrolled in the right plan for their needs.