Experience Excellence with COSI Agency: Your Premier Insurance Destination

Medicare Part C

Medicare Part C, also known as Medicare Advantage, covers all the benefits provided by Medicare Parts A and B. This includes hospital insurance (Part A) and medical insurance (Part B) coverage. Additionally, Medicare Advantage plans often offer extra benefits beyond what Original Medicare provides, such as prescription drug coverage (Part D), vision, dental, and hearing services.

These plans may also include wellness programs, gym memberships, and other health-related benefits. Medicare Advantage plans are offered by private insurance companies approved by Medicare, and coverage and costs may vary depending on the plan. It’s important to review plan details carefully to understand what is covered and any associated costs.

What Medicare Part C Covers (Medicare Advantage)?

Medicare Part C, commonly known as Medicare Advantage, offers comprehensive coverage that combines the benefits of Medicare Parts A and B. This means it includes all the services covered under hospital insurance (Part A) and medical insurance (Part B) of Original Medicare. Part C plans are offered by private insurance companies approved by Medicare and are designed to provide beneficiaries with an alternative way to receive their Medicare benefits.

In addition to the coverage provided by Parts A and B, Medicare Advantage plans often include additional benefits not offered by Original Medicare. These extra benefits may include prescription drug coverage (Part D), vision care, dental care, and hearing services. Some plans also offer wellness programs, gym memberships, and other health-related benefits aimed at promoting overall well-being and preventive care.

How Much Does Medicare Advantage Cost?

While some Medicare Advantage plans offer premiums as low as $0, it’s important to understand that these plans are not entirely free. Medicare provides a monthly payment to the insurance carrier to cover your care, allowing them to offer plans with a $0 premium.

It’s crucial to grasp the costs associated with Medicare Advantage to make informed decisions. While the additional benefits may seem appealing, it’s essential to consider the potential expenses. Let’s explore some of the possible costs associated with Medicare Advantage plans:

  • Deductibles: This is the amount you must pay for covered healthcare services before your insurance plan begins to contribute. For instance, if your deductible is $500, your plan won’t cover any costs until you’ve met the $500 deductible for covered services.
  • Copays and Coinsurance: These represent your portion of the expenses for a medical service. Copays are fixed amounts you pay for services, while coinsurance is a percentage of the service’s cost.
  • Maximum Out-of-Pocket: This is a limit set by the insurance carrier on your annual out-of-pocket expenses. Once you reach this limit, the plan covers 100% of your covered costs for the remainder of the year.

Types of Medicare Advantage Plans

Medicare Part C plans cater to a diverse range of enrollees by offering several different kinds of plans, each with unique features, network rules, and costs.

Medicare Advantage plans, also known as Medicare Part C, offer different types of plans to meet the diverse needs of beneficiaries. Each type of plan may have varying costs, coverage options, and rules for accessing healthcare services. Here are the main types of Medicare Advantage plans:

  1. Health Maintenance Organization (HMO) Plans:

    • HMO plans typically require you to choose a primary care physician (PCP) from a network of healthcare providers.
    • You generally need referrals from your PCP to see specialists or receive non-emergency care.
    • Out-of-network care is typically not covered, except in emergency situations.
  2. Preferred Provider Organization (PPO) Plans:

    • PPO plans offer more flexibility in choosing healthcare providers compared to HMO plans.
    • You can see any healthcare provider within the plan’s network without a referral, although you may pay less for in-network services.
    • Out-of-network care is usually covered, but at a higher cost to you.
  3. Private Fee-for-Service (PFFS) Plans:

    • PFFS plans determine how much they will pay healthcare providers and how much you will pay for covered services.
    • You can typically see any healthcare provider who accepts the plan’s terms and conditions, although some providers may choose not to accept PFFS plans.
    • Some PFFS plans have provider networks, while others do not.
  4. Special Needs Plans (SNPs):

    • SNPs are designed for individuals with specific health conditions, such as chronic illnesses or disabilities, or those who are dual-eligible for Medicare and Medicaid.
    • These plans tailor their benefits, provider choices, and drug formularies to meet the unique needs of their members.
    • Enrollment in SNPs is typically restricted to individuals who meet specific eligibility criteria.
  5. HMO Point of Service (HMOPOS) Plans and Medical Savings Account (MSA) Plans:

    • HMOPOS plans combine features of HMO and PPO plans, allowing you to receive care both inside and outside the plan’s network.
    • MSA plans combine a high-deductible health plan with a medical savings account, which you can use to pay for healthcare expenses.
    • Both HMOPOS and MSA plans offer flexibility in accessing care and managing healthcare costs.

A + B

If you're enrolled in both Medicare Part A and Part B, you're eligible to enroll in a Medicare Advantage plan

Eligibility for Medicare Advantage

Medicare Advantage plans are available to all Medicare beneficiaries who are enrolled in both Medicare Part A and Part B. To enroll in a Medicare Advantage plan, you must reside within the plan's service area, typically determined by your residential zip code.

Medicare Advantage Enrollment Periods

  1. Initial Enrollment Period (IEP): The Initial Enrollment Period is the first opportunity for most individuals to enroll in a Medicare Advantage plan. It begins three months before your 65th birthday month, includes your birthday month, and extends for three months after. If you qualify for Medicare due to disability, your IEP starts three months before your 25th month of disability benefits and ends three months after.

  2. Annual Enrollment Period (AEP): The Annual Enrollment Period, also known as the Fall Open Enrollment Period, occurs annually from October 15th to December 7th. During this time, Medicare beneficiaries can enroll in, switch, or disenroll from a Medicare Advantage plan. Any changes made during this period take effect on January 1st of the following year.

  3. Medicare Advantage Open Enrollment Period (MA OEP): The Medicare Advantage Open Enrollment Period runs from January 1st to March 31st each year. During this period, individuals who are already enrolled in a Medicare Advantage plan have the option to switch to another Medicare Advantage plan or disenroll from their current plan and return to Original Medicare. Changes made during the MA OEP take effect the first of the month following the request.

  4. Special Enrollment Periods (SEPs): Special Enrollment Periods are available throughout the year for individuals who experience certain qualifying events, such as moving to a new location, losing employer-sponsored coverage, or qualifying for additional assistance programs. SEPs allow beneficiaries to enroll in or make changes to their Medicare Advantage coverage outside of the standard enrollment periods.

COSI Agency: Your Medicare Solution

With COSI Agency, you can expect more than just guidance – you can expect a trusted partner dedicated to your well-being. We’ll take the time to understand your unique situation and offer solutions that give you peace of mind. From answering your questions to assisting with enrollment, we’re here to ensure that you have the support you need to make confident decisions about your Medicare coverage. Let us help you navigate the complexities of Medicare and find the plan that works best for you.

Choosing COSI Agency means opting for unbiased choices and personalized solutions. Unlike tied agents, we explore various carriers and coverage options. With no external agendas, we prioritize your well-being and financial goals, providing recommendations solely focused on securing your peace of mind.

Need Help?

Discover the most cost-effective Medicare plans available in your vicinity.

Your Trusted Independent Insurance
Broker In Colorado Springs


Schedule a free consultation with us today