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Does My Elderly Parent Qualify for Medicare Part C?

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Do you have questions concerning your elderly parent’s eligibility for Medicare or Medicare Advantage? No worries! MedicareInsurance.com is here to help. Simply contact us online via our live chat feature or give us a call at (800) 950-0608 to learn more about what your parent may be eligible for.

Just the Essentials…

  • Medicare is a government-managed health insurance program that is composed of four parts: Part A, Part B, Part C, and Part D.

  • Medicare Part C, also known as Medicare Advantage, is designed to give Medicare beneficiaries additional healthcare benefits beyond what is covered by Original Medicare, such as vision, hearing, and dental insurance.

  • Medicare Advantage plans are offered by private insurance companies and, as a result, their coverage benefits and costs may vary.

  • Individuals aged 65 or older may qualify for Medicare Part C, as may those diagnosed with certain disabilities and those who have received certain social security benefits.

  • MedicareInsurance.com can help your parent research and compare Medicare Advantage plans in their area, assisting them in learning more about which coverage may work best for them.

What is Medicare health insurance coverage?

Medicare is a health insurance program that is regulated and managed by the U.S. federal government. Medicare consists of multiple parts. While most people are familiar with Medicare Parts A and B, which are known collectively as “Original Medicare,” not everyone is as familiar with Medicare Part C. 

Medicare Part C is also known as Medicare Advantage. Offered by private insurance companies, Medicare Advantage plans are another way for people to receive Medicare benefits beyond what is covered by Original Medicare.

What is Medicare Advantage?

Medicare Advantage are bundled insurance plan options that typically include all the same benefits as Original Medicare, plus additional healthcare coverage like vision, dental, and hearing insurance.  Sometimes, Medicare Advantage can also include prescription drug coverage. These individual plans are regulated and approved by the U.S. federal government under Medicare law.

When your parent first enrolls in Medicare, they have the choice to stay with Original Medicare or switch to Medicare Advantage. Many people decide to enroll in Medicare Advantage because of its aforementioned additional coverage offerings.

Under the Medicare Advantage umbrella, there are many different types of plans. Depending on what your parent wants or needs in their healthcare coverage, they can choose from several different plan structures including:

Health Maintenance Organizations (HMOs)

A type of Medicare Advantage plan that is available in some areas of the country. Some HMOs cover additional benefits, like extra days in the hospital. In most HMOs, your parent can only see doctors, specialists, or hospitals on the plan’s list, except in an emergency, and are typically required to obtain a referral from their Primary Care Physician before seeing a specialist.

Health Maintenance Organizations-Point of Service (HMO-POS)

An HMO option that may allow your parent to visit doctors and hospitals outside their approved plan network at an additional cost.

Preferred Provider Organizations (PPOs)

A type of Medicare Advantage plan that may allow your parent to pay less if they use doctors, hospitals, and providers that belong to the plan’s network. Your parent can see doctors, hospitals, and providers outside of the network for an additional cost. In PPOs, referrals are not necessary to see a specialist.

Private Fee for Service (PFFS)

A type of Medicare Advantage Plan in which your parent may see any Medicare-approved doctor or receive treatment from any hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and what your parent must pay for the services they receive.

Special Needs Plans (SNPs)

A special type of plan that provides more focused health care for specific groups of people, such as those who have both Medicare and Medicaid, who reside in a nursing home, or who have certain chronic medical conditions.

Provider Sponsored Organizations (PSOs)

Medicare Advantage plans that are managed by a provider or group of providers. In a PSO, your parent can usually get healthcare from the providers who are part of the plan’s pre-approved list of doctors and facilities.

Medical Savings Accounts (MSA)

Medicare Savings Account plans typically have two parts: a high deductible health plan and a bank account. Medicare gives the plan a predetermined spend amount each year for your parent’s’ health care, and the plan deposits a portion of this money into your parent’s account. The amount deposited is often less than the deductible amount, so your parent may have to pay some out-of-pocket costs before this coverage begins.

Regardless of the type of plan your parent chooses, every Medicare Advantage plan must meet federal government standards such as:

  • Provide the same rights and protections as Original Medicare
  • Offer complete Medicare Part A and Part B coverage
  • Cover the recipient even if they have a pre-existing condition
  • Have a yearly limit for out-of-pocket medical services. Once the limit is reached, the cost will be zero

Who is eligible for Medicare Advantage?

The eligibility requirements for Medicare Advantage are really quite simple. First, your parent must be enrolled in Original Medicare Parts A and B, which can occur as soon as your parent turns 65. 

Additionally, your parent is eligible to enroll in Medicare if they can receive Social Security or Railroad Retirement Benefits. Active recipients of these benefits are enrolled automatically if they’ve received them for at least 4 months when turning 65, or they have received Social Security Disability benefits for at least 24 consecutive months. 

Once enrolled, your parent has the option to switch to Medicare Advantage, which can be done during their seven-month Initial Enrollment Period (IEP), the three months before their birthday, the month of their birthday, and three months after.

Outside of a person’s IEP, the most common period to elect a change to Medicare Advantage from Original Medicare is during the Open Enrollment Period, which occurs each year from October 15 to December 7. If your parent elects to make the switch during this time, they will generally remain in the newly chosen plan until the next fall’s enrollment.

Medicare Advantage vs. Original Medicare

Original Medicare allows your parent to go to any doctor or hospital that accepts Medicare. However, Original Medicare can carry out-of-pocket costs like 20 percent coinsurance payments and limitations such as a lack of Medicare Part D: Prescription Drug Coverage. To help manage expenses, your parent can also sign up for a Medigap plan or Medicaid, if they are a low-income individual.

Typically, Medicare Advantage eliminates the need for a Medigap plan and can sometimes include Medicare Part D depending on your chosen plan. Additionally, Medicare Advantage also covers the same basic benefits as Original Medicare, including:

  • Diagnosis and treatment for illnesses, diseases, and injuries.
  • Receipt of doctor-ordered devices and equipment like wheelchairs and oxygen 
  • Receipt of preventative screenings and care including vaccines.

Medicare Advantage can also include extra benefits depending on your parent’s specific plan. These may include meal delivery, non-medical transportation, over the counter medications, along with other benefits for fitness, dental, vision, and hearing coverage.

Unlike Original Medicare, some Medicare Advantage plans do require your parent to see doctors that are within the plan’s provider network. Others allow your parent to go to any doctor or hospital that accepts the plan at an added cost.

Why choose Medicare Advantage?

Many people choose Medicare Advantage to help manage their care expenses. Instead of paying 20 percent coinsurance costs for items and services covered under Medicare Part B, Medicare Advantage changes this expense to flat fees paid for certain services, called a copayment. Medicare Advantage also places a stop-loss amount on a beneficiary’s obligation to pay for covered out-of-pocket expenses.

That said, it is important to note that Medicare Advantage can require a premium to be paid every month on top of the Medicare Part B premium. However, monthly premiums can be as low as $0 depending upon the plan.

Wondering if Medicare Advantage is the right fit for your parent? Contact MedicareInsurance.com online via our live chat feature or by phone today at (800) 950-0608. Our team of licensed insurance experts will be happy to help your parent research and compare the many different Medicare Advantage plans they may be eligible for.

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