Medicare Part C

MR. WATSON: Medicare Part C : Medicare Advantage (I call this an HMO for seniors, but can be a PPO, etc..) Part C is an alternative to Parts A & B. You can not have A, B, & C together, no need.

MR. WATSON: These are....Medicare Advantage Plans. There are options that seniors may choose and they include managed care plans, HMOs, PPOs, private fee-for-service plans and specialty plans. These plans will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

MR. WATSON: Medicare Advantage Plans may offer extra coverage, such as

• vision,
• hearing,
• dental, and/or
• health and wellness programs.
• Most include Medicare prescription drug coverage (Part D).
• Some even pay your Part B premium

Remember, these were excluded under Parts A & B.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

MR. WATSON: With the HMO type of plan for seniors, the government pays the managed care plan. It works the same as for people not on Medicare who buy an HMO or PPO except for seniors, the government pays the HMO or PPO. The managed care company, (CIGNA, United Health Care, Humana, etc,) contracts with doctors and hospitals and either pays them in advance (capitation arrangement, HMO) or works out price agreements (fee for service. PPO). The health care providers agree to provide services to Medicare beneficiaries for a set monthly payment from Medicare. Look at it like a regular HMO or PPO plan except the government is paying the HMO on behalf of the senior.

MR. WATSON: With the PPO type of plan the seniors do not need a referral to see a specialist outside the network. They can see any physician that accepts Medicare. Just like any PPO.

MR. WATSON: To be eligible for any of the Medicare Advantage options, a Medicare beneficiary must be enrolled in both Medicare Part A and B.

Medicare Part D (Prescription Drugs

MR. WATSON: Medicare Part D : Prescription Drug

MR. WATSON: This is optional for anyone enrolled in Medicare. This drug benefit may be obtained from private prescription drug plans or Medicare Advantage (PPO) and all plans must offer basic coverage as well as enhanced coverages. A six-month initial enrollment period begins, and if a Medicare beneficiary does not enroll during the initial enrollment period, this being the period when he was first eligible, and decides to enroll later, they will pay a 1% penalty for each month of delayed enrollment, unless that person has comparable coverage from another source.

MR. WATSON: This coverage is offered either as stand-alone Prescription Drug Plans (PDPs) or Medicare private plans such as HMOs, PPOs, discussed above. Stand-alone plans only cover drugs. HMOs & PPOs (Part C) usually provide the health care and the drug coverage.