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Medicare Part C: Medicare Advantage

Dec 7, 2023 | Your Health

So far in this series, we have reviewed Medicare Part A and Part B. In this installment, we look at Part C with Ben Rothering, a licensed insurance salesman who specializes in helping guide people through the Medicare process.

“Medicare Part C is known as Medicare Advantage or MA plans, and they are offered by Medicare-approved private companies,” explains Rothering. “A lot of them will include drug coverage, but not all of them. So, that’s definitely something you want to look at and know what your own needs are—to make sure you get the coverage you need.”

The Advantage of Part C

Medicare Advantage plans provide coverage through a private insurance company. “If someone has A and B, you don’t need C. If you decide to pick up Medicare Advantage, which is Part C, then you are removed from Parts A and B. Essentially, you’re going to keep paying your Part B premium, but now that premium is going towards this private insurance company.”

In most cases, the Medicare Advantage plans available are managed care plans. “You’ll have an HMO or a PPO,” continues Rothering. “You’ll have to stay within that network and see doctors within those networks. If you want to get a second opinion from somebody who isn’t in the network, you’re going to need to get permission. You’ll have to get a referral.”

These plans also set a limit on what you must pay out of pocket each year for covered services. Some will offer non-emergency coverage that’s out of network, but typically at a higher cost.

Staying On Top of Part C

Rothering points out that the insurance companies that offer Medicare Advantage Plans must renew those plans every year. “If they don’t, you will get a letter in the mail, and you’ll have to find another product or other insurance coverage to help you out.”

“Your out-of-pocket costs can change over time with these plans,” concludes Rothering. “With Medicare Advantage plans, can change from year to year. They can add and subtract coverage. Costs can go up or down. So, it’s definitely something you want to make sure you’re keeping up with and you understand the coverage you have and any changes that are being made on a year-to-year basis.”

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