When people start looking for government healthcare, they inevitably turn to Medicare. It’s the most widely known program, and it’s beneficial for all Americans. However, there are many parts to Medicare, which can make it a little difficult to understand.
One thing to note is that Medicare Part C combines all Medicare plans and a few extras into one. What’s the difference between Original Medicare and Medicare Part C? For one, Medicare Part C is available through private health insurance companies, with sponsorship from Medicare. To further break it down, this guide goes through all of the different parts of Medicare Part C and Original Medicare.
What is Medicare Part C?
Medicare Part C is also called Medicare Advantage. It’s a government-sponsored healthcare plan that is available through a private health insurance company. If you’re wondering why you should enroll in this plan, rather than Original Medicare, there are a few reasons.
With Medicare Part C, you get the benefits of Original Medicare. Plus, you receive some extras that health insurance companies throw into each plan. For instance, they also include Part D (Prescription Drug Coverage). When all of these plans combine, they are referred to as a Medicare Advantage (MA) Plan.
Unlike with government healthcare plans, Medicare Part C plans are managed by private healthcare companies. Plans also offer different premiums and copays, based on your budget and income. You can pick and choose services and find a plan that really works within your budget. You can also change Medicare Part C during enrollment periods throughout the year.
What is Original Medicare?
Original Medicare was developed in 1965, as a way to give Americans healthcare through the government. Over time, the government program has evolved. It no longer just provides healthcare to those who are 65 and over. If you are disabled, or if you qualify under certain conditions, you could actually receive Medicare and reduce the costs of your medical bills dramatically.
Original Medicare Care consists of two parts:
- Medicare Part A: This covers you for hospitalizations when an emergency or something catastrophic happens. It can also cover skilled nursing facility costs, hospice care and home healthcare. Note: Medicare Part C does not include hospice care, but you can still receive it under Medicare Part A.
- Medicare Part B: This part of Medicare covers necessary medical services, like outpatient care, doctor’s visits and preventive care. You still pay a premium for Medicare Part B when you have Medicare Part C.
When you enroll in a Medicare Part C plan, you are still enrolled under Medicare. And, you receive all of the same rights and protections as if you had Original Medicare. The only difference is that you work with a private health insurance company. You may also receive some extras through the private company.
What is extra coverage for Medicare Advantage?
There are a few services that come with Medicare Advantage that you won’t find in Original Medicare. Some MA Plans include all of the following, while some are just basic plans. It’s best to check with your health insurance provider to see what they offer with their Medicare Part C plans.
These are some services that may be included with your Medicare Advantage Plan:
- Vision: MA covers all of your visits to the eye doctor and any exams that you may need. It may also cover lenses and surgery.
- Hearing: Some MA plans for the elderly will cover hearing aids and exams.
- Dental: Most Medicare Advantage Plans have some dental coverage. This would cover visits to the dentist, exams and cleaning.
- Prescription Drug Coverage: Part D is also typically included with Medicare Advantage plans.
Medicare Part D is supplemental. If you have Original Medicare, you may have to add Part D through a private insurance company anyway. With most Medicare Part C plans, it’s already included. However, you should always talk to a representative at a potential health insurance provider. They’ll let you know what benefits and costs are associated with the MA plans that you qualify for.
How to enroll for Original Medicare and Medicare Part C
Enrollment is the same for both of these plans. In fact, you have to qualify for Original Medicare in order to be eligible for Medicare Part C. There are some basic rules for eligibility. But many people who are eligible for Medicare don’t fall into these categories, as well.
You qualify for Medicare Part C and Original Medicare if:
- You are a U.S. citizen.
- You are about to turn 65, just turned 65 or are over the age of 65 and have a government-sponsored healthcare plan.
- You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid.
- Your spouse currently receives Medicare coverage.
- You have a disability and have qualified for Social Security benefits for 24 months.
- You have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease).
There are other ways that you might qualify. You can take a look at the Social Security Administration (SSA) website, SSA.gov; they provide a guide to Medicare benefits that lets you see if you are eligible.
You may qualify for Medicare Part A and Part B. Or, you may already be enrolled in Original Medicare. Either way, you qualify for Medicare Part C. Eligibility for Medicare Advantage Plans also depends on where you live. Some areas do not have plans for Medicare Part C. You also cannot have end-stage renal disease (ESRD) with MA plans.
In some cases, Medicare Advantage isn’t the best choice for individuals. For instance, those who need more coverage or who earned a very high income may want to consider another plan option. That is because the costs of Medicare are still based on your gross income. You should always speak to a representative first about the cost of any Medicare Advantage plan.
Understanding Enrollment Periods
There are specific enrollment periods for Original Medicare and Medicare Advantage. These are different times of the year that are set by the government. During these periods, you can enroll in Medicare, switch to Medicare Advantage or switch back to Original Medicare. Here are some tips for enrolling correctly in Medicare Part C.
- When you first become eligible for Medicare or when you turn 65; this depends on your Initial Enrollment Period (IEP):
- IEPs are different, based on your eligibility. Page 3 of “Understanding Medicare Part C & D Enrollment Periods” provides a chart with when you can enroll, related to your type of eligibility.
- When you enroll during a specific enrollment period; these occur each year and are set by the government. Look below for a breakdown of the dates associated with these enrollment periods.
- You may qualify for Special Enrollment Periods (SEPs) if you meet the following requirements:
- You moved
- You become eligible for Medicaid
- You qualify for Extra Help with Medicare Prescription Drug Plans
- You receive care from an institution, like a skilled nursing facility (SNF) or a long-term care hospital (LTCH)
Enrollment periods for Medicare Part C
These enrollment periods are different from Original Medicare. They occur throughout the year, as follows:
October 15 – December 7: Medicare Open Enrollment Period
You can change from Original Medicare to Medicare Advantage Plans during this time. You can also switch back to Original Medicare, if you currently have Medicare Advantage. You can make changes to your MA Plan or switch entirely to a new plan. If you want to add a prescription drug plan, you can also choose one to add during this period.
January 1 – February 14
You may leave your Medicare Part C plan and switch back to Original Medicare during this period. The Original Medicare coverage begins on the first day of the following month. If you switch back to Original Medicare during this period, you have until February 14 to join a Medicare Part D plan or prescription drug plan. You cannot switch from Original Medicare to Medicare Advantage plans during this period. You also cannot make changes to your Medicare Advantage Plan.
Original Medicare and MA Plans offer benefits to people who need health coverage for a lesser cost. They are also ideal for those who don’t have the ability to pay for health insurance. Medicare Part C plans can be quite beneficial for individuals and families who want to have a lower cost plan. They are also a good idea if you want to pay a little extra for more benefits, like vision and dental.
If you need help selecting a plan or want to compare plans, you can always use MedicarePartC.com tools to do so. We have hundreds of articles and videos to help you make the best decision for your healthcare needs. You may also want to check out HealthNetwork.com; here, you’ll find a variety of Medicare Advantage plans to consider.