Instead of having deductions taken from your Social Security check to pay for Part A and Part B, you may opt for Medicare Part C. It covers everything in Part A and Part B, but offers coverage in a way that may take the form of a health maintenance organization, preferred provider organization, Medical Savings Account, or other new type of health plan.
Medicare Part C incorporates the cost-saving measures of managed care into the Medicare program. You may find a managed care program that is cheaper than the premiums you now pay.
Medicare Part C is now called Medicare Advantage (MA). You can think of MA as your choice of health insurance plans, rather than as a government reimbursement plan.
In fact, under MA, you have a choice of a number of basic types of health insurance programs. Medicare will directly pay that program at a set rate, per member, per month for the basic coverage you would have had under original Medicare. These organizations, which are under contract to the Medicare program, will then be managing your access to health care providers.
Through MA, you have the following options for managed care plans (also known as coordinated care plans):
- Health Maintenance Organization (HMO) plans emphasize preventive care, but without coverage for providers or facilities outside the HMO network. They usually offer drug benefits.
- Point of Service (POS) plans offer a network of preferred providers, like HMO plans, but also provide reduced benefits for providers or facilities outside the HMO network. For you to access a network specialist, they typically require a referral from a network primary care physician. They sometimes offer drug benefits.
- Preferred Provider Organization (PPO) plans are similar to POS plans but have bigger geographic access to network providers in a larger service area, and with reduced benefits outside the PPO network. They do not typically require a referral from a network primary care physician to access network specialists. They may or may not offer drug benefits.
- Provider-Sponsored Organizations (PSO) plans are similar to the POS plans, but are usually organized with physicians that practice in a regional or community hospital. There may or may not be coverage for providers or facilities outside the PSO network, depending upon the plan designs offered. They may require a referral from a network primary care physician to access network specialists. They typically offer drug benefits.
If you sign up for one of these plans, and decide you don’t like it, you can change plans (although you may be locked in for a period of time) or you can go back to the original Medicare (Parts A and B).
Pros and Cons
Below are the pros and cons of Medicare C.
While you receive regular Medicare covered services, you usually pay much less in out-of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on a variety of factors, including whether the plan:
- Charges a monthly premium,
- Requires any deductibles or coinsurance payments, or
- Charges for extra benefits
Also, Medicare Advantage Plans may offer extra coverage, such as the following:
- Dental, and
- Health and wellness programs
Most plans also include Medicare prescription drug coverage (Part D).
These plans might have different rules for how you get services. For example, they might make you get a referral to see a specialist. Or, they might make you go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care.
If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan you have.
Call 1-800-MEDICARE or visit the Medicare website to help you decide if you want Part C or to make plan choices.