Tag: Part C

Medicare Advantage is a cost-saving option for many seniors to cover out-of-pocket expenses associated with Medicare. These plans include many additional benefits that Medicare does not. Putting together similar coverage using Part A and B would require adding a Part D plan to be comparable.

Insurance Companies

With Part C Plans, individuals receive Part A and B coverage from an insurance company, not Medicare. In exchange, the government makes payments to them to cover the cost. Insurance companies negotiate with local hospitals and doctors for reduced rates. Unlike Medicare, you will be required to use this specific network of providers with these plans.


Individuals continue to receive Medicare Part A and B coverage, as well as additional benefits not provided by Medicare. Most plans include benefits for prescriptions, dental, vision, fitness programs, and even hearing. Plans use a network of providers, and as a member, you agree to use the hospitals, doctors, and pharmacies in the service area. You can use providers who are not, but it will cost you more. It’s important to review your plan’s network requirements, If you don’t, you may be responsible for the total costs of services.

Cost of Plans

There are several different Medicare Advantage Plans to choose from, with varying premium amounts. Many companies offer $0 premium plans with additional benefits. Plans with no premium may be a cost-effective option, but they do have expenses like deductibles, and copays. The co-payment is in place of the 20 percent coinsurance you would pay under Medicare. Plans are required by law to put a maximum amount you will spend out-of-pocket for deductibles and copays each year.

Factors To Consider

Does the plan pay the Part B premium?

Does the plan provide extra benefits (prescription, vision, dental)?

What is the yearly deductible amount?

What is the cost for each doctor visit (copayment, coinsurance)?

What are the requirements and costs of network providers and out-of-network?

What is the out-of-pocket maximum?


You can enroll in Part C (Medicare Advantage plan) during specific times of the year. Enrollment periods were created to make it easy to get the coverage you need. However, outside of these dates, Medicare often requires that you stay with the plan you have until the following year. There are exceptions and in some cases, you may enroll outside of designated periods.

Initial Enrollment

The best time to enroll is during your Initial Enrollment period, or when you are first eligible to receive Medicare. Every senior in IL has an Initial Enrollment period that begins 3 months before you turn 65 and ends three months after. If you are disabled, your Initial Enrollment period begins 3 months before your 25th month of benefits and ends 3 months after your 25th month of benefits.

Annual Enrollment

Once you join Medicare, you can enroll in a Medicare Advantage plan during Annual Enrollment, October 15 through December 7 of each year. During this time, you can enroll, change, or drop a plan. If you miss the December 7 deadline, you may have to wait until the following year unless you qualify for a Special Enrollment.

Open Enrollment

If you are not satisfied with your plan, January 1st to March 31st is the time to make changes. You can change from Part C back to Medicare, or change a Part C plan to a different one. All changes take effect the following month.

Special Enrollment

Medicare realizes that some situations make it difficult to meet the enrollment periods. A Special enrollment was created to provide all seniors with the same opportunity.



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Medicare Advantage Stats: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/


Tag: Part C

Many seniors want to know the difference between a Medicare Supplement and Medicare Advantage Plans. These two plans have different coverage and benefits to fit each individual’s needs and budget.

Medicare Supplement

Medicare Supplement Plans are offered through private insurance companies in IL. These plans help pay for costs not covered by Medicare, like deductibles, copayments, and coinsurance. There are no networks and you are free to use any doctor or healthcare provider you choose who accepts Medicare.

Medicare Advantage

Part C is offered through private insurance companies approved by Medicare. When you join a plan, you still have Medicare coverage. Part A and B benefits are provided through the insurance company. Many plans offer low or zero monthly premiums. Most plans have additional benefits not provided by Medicare including prescription coverage and dental and vision care.



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Medicare Advantage: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html

Medicare Supplement: https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html

Extra: https://www.medicare.gov/supplement-other-insurance/medigap/medigap-and-medicare-advantage/medigap-and-medicare-advantage-plans.html


Tag: Part C

Sometimes, even when you think you’ve made the right choice in a Medicare Advantage Plan, you review your coverage and need to make changes. Whether it’s because you’re moving out of your plan’s service area, or you simply want to change coverage or return to Medicare, there are rules and enrollment periods regarding when you can.

Annual Enrollment

Annual Enrollment is the time to make changes to an existing plan. During this time, you can add, drop, or switch without any penalty or restrictions. You can also join or drop a Part D Plan, or switch from one plan to another. All changes you make during this period will become effective on January 1. This period isn’t just for Part C or Part D. All Medicare beneficiaries are allowed to make changes to their coverage during this time. This is the time to look at other options in your area to make sure all of your healthcare needs will be met the following year.

Open Enrollment

The Open Enrollment Period extends from January 1 through March 31. This is the time for you to drop your plan and return to Medicare plus a Part D Plan or change from one Part C Plan to another. All changes made during this period will be effective on the first day of the following month.

Special Enrollment

Special Enrollment Periods were created for people who need to make changes at other times throughout the year. New coverage typically begins the first day of the month after you disenroll from a previous plan. You may switch from your current plan and join a new plan at any time during the year if the new plan has an overall performance rating of 5 stars.



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Medicare Advantage Disenrollment


5-star enrollment period



Tag: Part C

Medicare Advantage is a cost-saving option for seniors in Illinois, providing coverage that helps with the cost and coverage gaps in Medicare. Understanding the differences between the various plans will help you make an informed decision. Factors like cost, referrals, and whether or not you can use hospitals and doctors outside a plan’s network.

Health Maintenance Organizations

An HMO plan typically requires that you select a primary care doctor from the plan’s network of providers. In most cases, you’re required to use doctors, health care providers, and hospitals within the plan’s network, except in an emergency. You may need a referral to see a specialist. Compared to other plans, this plan can be a cost-effective option, but you may pay the full cost of care if you do not follow the rules. Prescription drug coverage is usually covered but individual plans vary.

Preferred Provider Organizations

PPOs tend to be less restrictive than HMOs, but increased flexibility can cost you more. You do have the option to use any doctor, specialist, or hospital you choose, but you will pay less if you stay within the plan’s network. A referral is generally not required to see a specialist. Prescription coverage is often covered, but individual plans vary.

  • Private Fee for Service

    The type of plan decides how much it will pay doctors and hospitals, and how much you will pay. If the plan has a network of providers, you don’t need to go to doctors or hospitals on the list. However, not all Medicare providers accept this plan. Typically, with a PFFS, you do not need to get a referral to see a specialist. Prescription coverage may be covered, but plans vary.

  • Special Needs

    Membership in a Special Needs Plan is limited to people with specific diseases or who have specialized health needs. If you have a severe chronic condition, live in a nursing home, or receive both Medicare and Medicaid, you may be eligible.

There are also Provider Sponsored Organizations (PSOs), and Medicare Medical Savings Accounts (MSAs). Regardless of the type of plan, all cover all Medicare services. They’re required to offer at least the same benefits as Medicare, but most offer more. Many plans include benefits for dental, vision, and prescriptions, benefits not offered through Medicare. 



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HMO: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/hmo-plans.html

PPO: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/preferred-provider-organization-plans.html

PFFS: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/private-fee-for-service-plans.html

SNP: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html

MSA: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-savings-accounts/medical-savings-account-plans.html


Tag: Part C

Many Illinois seniors do not realize that coverage and benefits change yearly with Part C plans, or fail to review the Annual Notice of Change before Annual Enrollment.

Review Coverage

As a member of Part C, each fall, you should receive an Annual Notice of Change. This document includes information about changes to your plan that will take effect the following January. Changes to your premium, deductibles, copayments, prescription, and network providers. Your maximum out-of-pocket limit may be reduced. This is your opportunity to review your coverage and decide if your plan still meets your needs.

Benefit Changes

Small changes can have a significant impact on your coverage and benefits, how much you pay out-of-pocket, and where you can go to receive services. Review network changes that may affect the doctors and hospitals you use. Your plan’s medication formulary may cover fewer medications next year. It’s a good idea to review the list carefully to ensure the medications are on the list and still available, and the pharmacy you use. Look for changes in how much you will need to pay to continue receiving the prescriptions you use regularly. It’s also important to review network changes that may affect the doctors and hospitals you use for your medical care.

Different Plans

There are many different Part C plans, some with prescription benefits included, and some without. HMOs and PPOs are not required to offer prescription benefits. If you choose this type of plan that does not offer coverage, you may not join a separate Part D plan. Plans must send an Annual Notice of Change no later than September 30, a couple of weeks before the start of Open Enrollment. If you don’t receive it, contact your plan administrator or agent. Details on how to request the notice can be found on the back of your membership card. If you decide to keep your plan, you don’t need to do anything at all and you will automatically be re-enrolled in your plan for another year.


Most plans do include benefits for prescription drugs, but no two plans are alike. It makes sense to find the one that fits your prescription needs best. If you take specific medications, compare plans by looking at the drugs that are included on the formulary, and be sure to identify which tier or tiers they are assigned to, how much they cost, and what pharmacies are in the network.



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Annual Notice of Change: https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html