Medicare Part C Definition

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Medicare Part C provides Medicare participants with more flexibility than Part A alone.
Medicare Part C provides Medicare participants with more flexibility than Part A alone. (Image: stethoscope image by Adam Borkowski from Fotolia.com)

Medicare is a federally-subsidized health insurance plan for the country’s senior citizens who are at least 65 years old as well as individuals under 65 with a qualifying medical disability or disease. Medicare Part C is an optional coverage plan allowing recipients to receive their health care from an authorized provider.

Medicare Eligibility Requirements

Permanent residents and U.S. citizens over 65 are eligible to receive Medicare coverage if they are eligible for Social Security benefits, were government employees or the spouse of a government employee who paid enough in Medicare taxes to receive benefits or a railroad retirement pension. Additionally, parents of deceased children previously receiving benefits are eligible for Medicare coverage. Those under 65 are eligible if they received Social Security disability for at least two years or qualify through other Medicare coverage rules for disabled individuals.

Medicare Coverage Parts A Through D

Medicare Part A is hospital insurance for inpatient stays. Part A also covers limited stays in nursing homes, following inpatient hospital admissions or hospice care. Part A is typically provided at no additional cost for eligible enrollees. Medicare Part B covers fees for physicians and supplies or other services that Part A does not cover. Part C, provider-specific health care, and Part D, prescription drug benefits, are optional Parts of the Medicare program. Parts B, C and D are usually subsidized in part by the Medicare patient.

Part C: Medicare Advantage Plans

Patients who receive Medicare Part A and Part B can apply for the Medicare Advantage plan. There are several plans offered through Part C. Part C covers benefits through preferred provider organizations (PPOs) and managed health maintenance organization (HMO) plans. It also provides optional fee-for-service coverage and specialty programs. Patients who enroll in Part C receive a Medicare health card to use when they receive services. Enrollment periods for Part C are limited. Patients must enroll during initial Medicare enrollment or open enrollment, between November 15 and December 31 of each calendar year. The plan covers emergency care visits as well as additional medical services, such as dental and vision services. Medicare subsidizes a portion of the Part C premium, but depending upon the plan chosen, individuals cover the remaining premium.

Part C: Private Companies

Part C is provided through private health care organizations or companies that have received the government’s approval for offering health care management through Medicare. Each provider determines the applicable monthly premium amount, copayment fees or minimum deductibles that must be met. Additionally, some plans require patients to receive pre-approval to visit a specific doctor and allow coverage for doctors pre-qualified to provide services.

Applying for Coverage

Those individuals already receiving retirement or disability benefits through the Social Security Administration can enroll automatically for Medicare coverage when they turn 65. The Social Security Administration contacts these individuals directly and enrolls them in Medicare Part A. The other parts of Medicare are optional because there are monthly premiums for coverage.

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