Haris Ashley
Medicare Advantage (MA), also known as Medicare Part C, is a type of health insurance offered by private companies that contract with Medicare. It provides Part A (Hospital Insurance) and Part B (Medical Insurance) coverage, as well as additional benefits like vision, hearing, and dental care. Medicare Supplement Insurance Plan C, on the other hand, is available to those aged 65 and older enrolled in Medicare Parts A and B and covers most Medicare-approved medical expenses, including hospitalization, skilled nursing facility care, and medical expenses. It's important to note that Medicare Supplement Insurance plans are not connected with or endorsed by the US government or the federal Medicare program.
| Characteristics | Values |
|---|---|
| Plan type | Medicare Supplement Insurance Plan |
| Availability | Only available to Medicare beneficiaries who were eligible before January 1, 2020 |
| Coverage | Hospitalization, medical expenses, skilled nursing facility care, blood |
| Discount | 6% off monthly premium when enrolling online (not available in CA, CT, OH, and PA) |
| Limitations | Limited to Medicare-approved charges; may need to pay additional out-of-pocket expenses |
| Insurers | Humana Insurance Company, HumanaDental Insurance Company, Humana Health Insurance Company of Florida Inc., and more |
| States covered | AK, AZ, CA, DC, DE, HI, IA, LA, ME, MN, MO, MT, NE, NH, NJ, OR, RI, SC, SD, VT, WI, WV, WY, AR, UT, CT, IN, KS, MA, NC, NM, NV, OH, OK, VA, MI, KY, AL, GA, IL, MS |
| Age eligibility | Age 65 and older; in some states, those under 65 with eligibility due to disability or End Stage Renal disease |
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What You'll Learn
Medicare Supplement Insurance Plan C
Medicare Supplement Insurance, also known as Medigap, is extra insurance you can purchase from a private health insurance company. It helps pay for your share of out-of-pocket costs in Original Medicare (Part A and Part B). Medigap policies are standardized and named by letters, such as Plan C, Plan F, or Plan G. These lettered plans offer the same benefits regardless of the insurance company, with price being the only differentiating factor.
Medicare Supplement Plan C covers most of your out-of-pocket costs in Medicare. The only exception to this is the excess charges for Part B. It is important to note that Plan C is not available to individuals who turned 65 years old on or after January 1, 2020, or to some people under the age of 65. However, if you were eligible for Medicare before this date but have not yet enrolled, you may still be able to purchase Plan C.
Original Medicare, which consists of Part A (Hospital Insurance) and Part B (Medical Insurance), is a prerequisite for buying a Medigap policy like Plan C. In most cases, you can only join a Medicare Advantage Plan if you have both Part A and Part B. Medicare Advantage is an alternative to Original Medicare offered by private companies, and it often requires you to use doctors within the plan's network.
Medigap policies, including Plan C, can help provide additional coverage for out-of-pocket costs not covered by Original Medicare. It is important to consider your specific needs and compare the benefits offered by each Medigap plan to determine which one best suits your requirements. Additionally, seeking guidance from resources like the State Health Insurance Assistance Program (SHIP) can provide personalized health insurance counselling to aid in your decision-making process.
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Medicare-approved charges
If a provider accepts assignment, it applies to all Medicare-covered Part A and Part B services. However, some providers may not accept assignment and instead choose to accept the Medicare-approved amount on a case-by-case basis. These non-participating providers can sometimes charge up to 15% above the Medicare-approved amount, known as "the limiting charge." It is important to note that Medicare won't pay for items or services from a provider that has opted out of the program, except in emergencies.
Medicare Supplement Insurance Plan C, also known as a Medigap policy, covers most of the costs you'd have to pay for Medicare-approved medical expenses. It includes benefits such as hospitalization, medical expenses, and skilled nursing facility care coinsurance. Plan C offers all the advantages of Plans A and B, plus additional coverage. It is important to note that Plan C is only available to Medicare beneficiaries who were eligible before January 1, 2020.
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Medicare Advantage (MA)
To participate in Medicare Advantage, an individual must opt to receive Medicare coverage through an MA plan. Once this choice is made, the individual must generally receive all of their care through the plan's providers to be covered by Medicare. MA plans combine Part A (Hospital Insurance) and Part B (Medical Insurance) and often include Part D (Prescription Drug Coverage) in a single plan.
MA plans are offered by private insurance companies that contract with Medicare and must follow the rules set by Medicare. These plans aim to manage healthcare costs while providing necessary care. One of the main goals is to reduce costs while also ensuring necessary care is provided. MA plans may offer extra coverage, such as vision, hearing, dental, and health and wellness programs.
The costs associated with MA plans can vary. Enrollees typically pay the same monthly premium as those in traditional Medicare Part B, unless the MA plan provides an extra benefit by covering some of the Part B premium. MA plans can also charge an additional monthly premium for Part D prescription drug coverage.
It is important to note that Medicare Advantage enrollees may be limited to a network of specific providers, unlike traditional Medicare, which does not have a network restriction.
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Medicare Initial Enrollment Period (IEP)
The Medicare Initial Enrollment Period (IEP) is a seven-month window that begins three months before your 65th birthday, includes the month of your birthday, and ends three months after. For example, if your birthday is on June 10, your IEP will be from March 1 to September 30. However, if your birthday falls on the first day of the month, your IEP will be calculated as if your birthday is on the last day of the previous month. So, if your birthday is on June 1, your IEP will be from February 1 to August 31.
During the IEP, you can enrol in Original Medicare Parts A and B, which provides coverage for inpatient hospital, skilled nursing facility, and long-term hospital care, as well as medical services. If you are already receiving Social Security or Railroad Retirement Board benefits, you may be automatically enrolled in Medicare Parts A and B during your IEP. You will receive your Medicare card in the mail before your 65th birthday, along with information about your coverage.
In addition to Parts A and B, you can also enrol in Medicare Part C (Medicare Advantage) and Part D (Prescription Drug Plan) during your IEP. These parts are offered by private insurers and can provide additional coverage, such as prescription drug coverage, dental, travel, and fitness benefits. It is important to consider your personal situation, health, and lifestyle needs when choosing your Medicare coverage during the IEP.
If you miss your IEP, you may still be able to enrol in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, you may have to pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty increases the longer you wait, so it is important to enrol as soon as you are eligible during your IEP.
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Humana’s Medicare Advantage plans
Medicare Advantage (MA), also known as Medicare Part C, is a type of Medicare insurance plan offered by private, Medicare-approved companies. Humana is one such company that offers Medicare Advantage plans.
Humana's Medicare Advantage plans offer all the benefits of Original Medicare Parts A and B, and most plans include coverage for prescription drugs. Additionally, Humana's Medicare Advantage plans come with a yearly limit on out-of-pocket expenses, after which you pay nothing for covered services for the rest of the plan year.
Humana's Medicare Advantage PPO plans allow enrolees to visit any Medicare-approved doctor who accepts the plan's terms. The company also offers HMO and PFFS plans.
Humana's Medicare Advantage plans can be customized with extra benefits, such as routine dental, vision, and hearing care. Certain plans also offer an allowance for eligible groceries, over-the-counter products, utilities, rent, pet supplies, and more.
The projected average premium for a Medicare Advantage plan in 2025 is $17 per month, but there are additional costs to consider, such as copays and deductibles. The cost of a Humana Medicare Advantage plan will depend on the specific plan chosen and the enrollee's location.
To enrol in a Humana Medicare Advantage plan, individuals can sign up during their Initial Enrollment Period (IEP) for Medicare, which starts three months before the month they turn 65 and ends three months after. If an individual already has Original Medicare and wants to switch to Medicare Advantage, they can do so during Medicare's Annual Enrollment Period (AEP), which runs from October 15 to December 7.
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Frequently asked questions
Plan C insurance, also known as Medicare Advantage, is a type of insurance plan offered by private companies that contract with Medicare.
Plan C insurance provides Part A (Hospital Insurance) and Part B (Medical Insurance) coverage, as well as additional benefits like vision, hearing, and dental care. It also covers Medicare-approved charges, skilled nursing facility care coinsurance, and Medicare Part B coinsurance.
Plan C insurance is available to individuals aged 65 and older enrolled in Medicare Parts A and B. In some states, it is also available to those under 65 who are eligible for Medicare due to disability or End Stage Renal Disease.
You can enroll in Plan C insurance during the Medicare Initial Enrollment Period (IEP) or the Annual Enrollment Period (AEP). The IEP starts 3 months before the month you turn 65 and ends 3 months after. The AEP runs from October 15 to December 7.
