Texas Part C of Medicare

Medicare Part C, also known as Medicare Advantage, is an alternative to traditional Medicare coverage (Part A and Part B) that is offered by private insurance companies approved by Medicare. With Medicare Advantage plans, you still receive your Medicare benefits through a private insurance company, but the company must follow Medicare guidelines for coverage.

Medicare Part C plans typically offer the same coverage as Original Medicare (Part A and Part B), but can also include additional benefits such as prescription drug coverage (Part D), vision, hearing, dental, and wellness programs. These additional benefits may vary by plan, so it’s important to review the specific details of each plan.

In addition to providing the same coverage as Original Medicare, Medicare Advantage plans also have an out-of-pocket maximum limit to protect you from high medical costs. Once you reach this limit, the plan covers 100% of your medical costs for the rest of the year.

There are several types of Medicare Advantage plans, including:

• Health Maintenance Organization (HMO) plans: In an HMO plan, you typically need to choose a primary care physician (PCP) who coordinates your care and refers you to specialists within the plan’s network.
• Preferred Provider Organization (PPO) plans: PPO plans typically allow you to see any provider within their network, but you may pay more if you go out-of-network.
• Private Fee-for-Service (PFFS) plans: With a PFFS plan, you can go to any provider that accepts the plan’s payment terms and conditions, but you may pay more if the provider does not accept the plan’s payment.
• Special Needs Plans (SNP): SNPs are designed for people with certain health conditions, such as diabetes or end-stage renal disease (ESRD), or those who live in nursing homes.
• Medical Savings Account (MSA) plans: MSA plans combine a high-deductible health plan with a savings account that you can use to pay for medical expenses.

It’s important to note that if you enroll in a Medicare Advantage plan, you still need to pay your Part B premium, as well as any additional premium charged by the plan. Additionally, if you enroll in a Medicare Advantage plan, you cannot also enroll in a Medicare Supplement Insurance (Medigap) plan.

Overall, Medicare Part C offers an alternative way to receive your Medicare benefits, with potentially additional benefits and an out-of-pocket maximum limit to protect you from high medical costs.