Medicare Part C Coverage and Enrollment: What You Need to Know


Last time, we discussed Medicare coverage and enrollment in general. Now let’s look at Medicare Part C in greater detail.

Medicare Advantage Plans

What Does Medicare Part C Offer?

As you’ll recall, Medicare Part C, also known as Medicare Advantage, is administered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, it will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as dental, vision, hearing, and/or health and wellness programs. Most of them include prescription drug coverage as well. If a particular plan does not offer prescription drug coverage, you can obtain it by choosing a Medicare Part D plan.

Medicare pays a fixed amount for a person’s care every month to the companies offering Medicare Advantage Plans. These companies are required to follow rules set by Medicare. However, each Medicare Advantage Plan can charge various out-of-pocket costs and use different rules for how a person obtains services.

How Do Medicare Advantage Plans Work?

There are two basic types of Medicare Advantage Plans—Managed Care and Fee For Service. Managed Care Plans (HMOs, PPOs, etc.) maintain a network of doctors and providers. They generally charge lower premiums and copays than Fee For Service Plans. However, Managed Care Plans typically place limits on the doctors and providers you can use, the treatments doctors are authorized to provide, and the length of time you can stay in a hospital.

Fee For Service Plans, on the other hand, offer greater flexibility regarding your choice of physicians and providers, but this flexibility comes with a lack of predictability. For example, you won’t know if a physician or other provider will cover a certain test or procedure until you need it. That is, the doctor or provider might accept your plan in general but might not accept the plan’s rules governing certain treatments and procedures.

Medicare Part C Enrollment Periods

There are several different enrollment periods for Medicare Part C. As we noted in our previous post, initial enrollment for Medicare begins three months before your 65th birthday and continues for seven months thereafter. The same is true for initial enrollment in Medicare Part C.

 Open enrollment for Medicare Part C runs from October 15 to December 7. If you have Medicare, you can join, switch, or cancel a Medicare Advantage Plan during this time frame and your coverage will begin on January 1.

General enrollment for Medicare Part C begins on January 1 and ends on March 31. You can enroll in Medicare Part C during this period if you already have Part A and would be signing up for Part B for the first time.

When Can You Switch Out of a Medicare Advantage Plan?

From January 1 through February 14, you’re allowed to switch from a Medicare Advantage Plan to Original Medicare (Parts A and B). However, you may not: 

  • Switch from Original Medicare to Medicare Advantage;
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan; 
  • Switch prescription drug plans; 
  • and join, switch, or cancel a Medicare Savings Account.

Given the high cost of medical care, investing enough time to choose the Medicare options that are right for you can be one of the best investments you’ll ever make.

Experienced Elder Law Attorney to Help Advise You

Clifford M. Cohen has more than 35 years of experience and dedicates his practice to guiding aging individuals in the Maryland and D.C. area through all facets of elder law care. Contact us today at 202-895-2799 for a free case evaluation.