Getting Started ›
Other Parts of Medicare
- Home
- Getting Started
- Other Parts of Medicare
Other Parts of Medicare
Part C (Medicare Advantage Plans)
- Combines medical, hospital, and sometimes even prescription drug coverage, or extra benefits in a single, all-in-one plan.
- Private insurance companies offer these plans. You’ll still pay your Medicare Part B premium every month.
- Medicare Advantage plans do not replace Medicare and are not Medicare Supplement plans, either.
- Part C plans provide an alternative to Original Medicare (Part A Hospital and Part B Medical).
Part D (Prescription Drug Plans)
- Original Medicare (Part A or B) doesn’t cover most prescriptions.
- Part D plans add extra coverage and are part of the government’s Medicare program.
- You can get Medicare Part D plans from a private insurance company. Each plan offers their own formulary (a list of covered drugs).
- Part D plans help pay for medications you take regularly to manage chronic conditions like heart disease, high cholesterol, or asthma.
Part C Medicare Advantage
Medicare Advantage plans (Part C) provide all Part A (hospital) and Part B (medical) coverage and must cover all medically necessary services. Many plans also offer additional programs not covered by Original Medicare. To enroll in a Medicare Advantage Plan, you must already have Original Medicare Part A and B coverage.
Coverage
Some of the medically necessary services covered by Medicare Advantage plans and Original Medicare include:
- Primary care and specialist doctor visits
- Laboratory tests
- X-rays
- Emergency ambulatory services
- Durable medical equipment
- Preventive tests and vaccines
- Physical therapy
Medicare Advantage plans can also include prescription drug coverage. (To get the same coverage with Original Medicare, you’d have to buy a separate prescription drug plan and pay a separate premium.)
Since Medicare Advantage plans are offered by private companies, they can be customized with extra benefits. Some benefits may provide coverage for:
- Routine dental care (dental exams, X-rays, teeth cleanings)
- Routine vision care (eye exams, eyeglasses and contacts)
- Routine hearing care (hearing tests, hearing aids)
- Fitness programs
- Gym memberships
- Transportation to doctor visits
- Over-the-counter drugs
Enrollment
Your first chance to sign up for Medicare Advantage is during your Medicare Initial Enrollment Period (IEP). The IEP for Medicare starts 3 months before the month you turn 65 and ends 3 months after.
If you have Original Medicare and want to enroll in Medicare Advantage for the first time, you can choose a Medicare Advantage plan during Medicare’s Annual Enrollment Period (AEP). Medicare’s AEP runs from Oct. 15 to Dec. 7.
If you’re already enrolled in Medicare Advantage, you can switch plans during the Medicare Advantage Open Enrollment Period (OEP). The Medicare Advantage OEP runs from Jan. 1 to March 31, or the annual enrollment period for Medicare.
Cost
Depending on the Medicare Advantage plan you choose, your out-of-pocket costs can vary:
- You may pay a deductible, a certain amount you must meet before your plan begins to pay.
- There may be copays for doctor visits—this is a flat fee usually due at the time of the visit.
- You may have to pay a share for lab services and medical equipment.
- You will pay a monthly plan premium if there is one. (Depending on your area, there may be plans available with $0 monthly premium. Speak to an AMAC agent for more information.)
- You will continue to pay the Original Medicare Part B monthly premium, as well.
- Additional coinsurance or copays if you see providers outside your plan network.
To help control costs, be sure you understand the terms of your plan and the out-of-pocket costs you may be required to pay.
Part D Prescription Drug Plans
Medicare Part D Prescription Drug Plans are part of the government’s Medicare program, but they are offered and managed through approved private insurers. These plans help lower the cost of prescription drugs.
If you are entitled to Original Medicare Part A and/or enrolled in Medicare Part B, there are two ways you can get Part D Prescription Drug coverage.
- Enroll in a separate, or standalone, Medicare Part D Prescription Drug plan (when you turn 65 or during Open Enrollment).
- Join a Medicare Advantage plan (Part C) that includes drug coverage. (Not all Medicare Advantage plans include drug coverage. Be sure to check the details of any plan before enrolling.)
Part D plans vary in costs from company to company and year to year. You might encounter:
- Copays and coinsurance
- Monthly premiums
- Annual deductibles
If you choose a Medicare Advantage Plan that includes drug coverage, your monthly plan premium will include the medical and drug portion of the plan.
Note: In some cases, your premium may be higher (Late Enrollment Penalty) if you didn’t sign up for Part D when you first became eligible. You may have to pay a late-enrollment penalty if you don’t join a Medicare Part D drug plan when you are first eligible for Medicare and you go without creditable prescription drug coverage for 63 continuous days or more.
