Part C offers alternative health plan options to the traditional Medicare program. If a patient joins one of these plans, all of their Medicare-covered health care services are covered through that plan.
To join a Medicare Advantage Plan, patients must be enrolled in and pay their monthly premiums for Medicare Part A and Part B. Patients will have to pay the monthly Medicare Part B premium to Medicare. In addition, they might have to pay a monthly premium to the Medicare Advantage Plan for the extra benefits that they offer.
Medicare Advantage Plans are required to have at least the same benefits as traditional fee-for-service Medicare (Parts A and B), and sometimes these plans offer additional benefits such as prescription drugs, eyeglasses, hearing aids, or extra home care services. These plans may be structured as:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-For Service (PFFS)
- Medical Savings Accounts (MSAs)
Explanations of these types of plans are available in the Private Payer Overview section of this Web site.
Medicare Advantage also includes Special Needs Plans (SNPs), which are plans that exclusively or mostly serve special patient populations, such as those in nursing homes, those with specific severe, chronic, or disabling conditions, or those who are eligible for both Medicare and Medicaid ("dual eligibles").
Just like private insurance plans, coverage parameters and patient financial responsibilities for Medicare Advantage Plans vary. So, it is important to verify insurance benefits for patients enrolled in Part C. Medicare Advantage plans may apply different rules for obtaining coverage, like requiring prior authorizations for services or referrals for specialists. An Astellas Reimbursement ServicesSM (ARS) reimbursement specialist can assist you in determining coverage for your patient's Medicare Advantage Plan.
| 2009 Part C Patient Expenses | ||
| Premium | Deductible | Co-insurance |
|---|---|---|
| Varies by plan, usually an amount in addition to the Part B premium | Varies by plan | Varies by plan |
