Part C (Medicare Advantage plans)
Medicare Part C isn't a separate benefit; Part C refers to Medicare Advantage plans, which combine your benefits from Parts A, B, and sometimes D (prescription drugs) in a single plan.
Medicare Advantage plans are offered through private companies and must be approved by the Centers for Medicare & Medicaid Services (CMS). These plans can offer additional benefits such as vision, hearing, and dental benefits, and health and wellness programs.
To ensure your care is covered, you may need to receive your care within the plan's specific provider networks and at preferred hospitals.
Medicare Advantage plans usually feature:
- No or minimal medical deductibles
- Simple copays for most covered services
- Limits on your out-of-pocket expenses
- Coverage for urgent or emergency care when traveling outside the United States
- Coverage for chiropractic care
- Fitness benefits
Medicare Part C must cover all of the services that Parts A and B cover except hospice care (still provided by Original Medicare).
Eligibility
To enroll in a Medicare Advantage plan, you must:
- Be entitled to Part A and enrolled in Part B.
- Maintain a permanent residence for at least 6 months out of the year in your chosen plan's service area.
- After you enroll, continue to pay your Part B premium as well as any Medicare Advantage plan premium.
Note: You are eligible to enroll in Original Medicare (Medicare Part A and Part B) if you have been diagnosed with end stage renal disease (ESRD). In most cases, if you have end-stage renal disease (ESRD), you can't join a Medicare Advantage health plan.
Types of Medicare Advantage plans
HMO
HMO (Health Maintenance Organization) plan members generally see doctors, specialists, or hospitals that are part of the plan's network, except for an emergency, out-of-area urgent care, or out-of-area dialysis.
PPO
A PPO (Preferred Provider Organization) plan has a network of providers, but members can also use out-of-network providers for covered services. Typically in-network services cost the member less out of pocket than out-of-network services. Providers must accept Medicare to ensure care is covered.
SNP
A SNP (Special Needs Plan) is a type of Medicare Advantage plan that is limited to certain Medicare beneficiaries, such as those in certain care facilities (like nursing homes), those eligible for both Medicare and Medicaid, or those with certain chronic or disabling conditions. Members generally see doctors, specialists, or hospitals that are part of the plan's network, except for an emergency, out-of-area urgent care, or out-of-area dialysis.
MSA
An MSA (Medical Savings Account) plan combines a high-deductible health plan with a Medical Savings Account that members can use to manage their health care costs. Once the deductible is met, the plan covers 100 percent of Part A and Part B costs.
Also:
- There are no premiums for MSAs.
- Beneficiaries must still pay a Part B premium.
- Prescription drugs are not covered in an MSA plan, although enrollment in a prescription drug plan is permitted.
PFFS
A PFFS (Private Fee-For-Service) plan is a type of Medicare Advantage plan in which a beneficiary is not limited to a specific network of providers. An enrollee may receive covered services from any provider in the United States who accepts Medicare and agrees to the PFFS plan's terms and conditions for payment. Providers are not required to accept PFFS plan enrollees, and may or may not decide to provide care to beneficiaries. It is the responsibility of the enrollee to notify a provider of their PFFS coverage prior to the visit.
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Learn about Medicare plans for group, state, and federal employees
If you are becoming eligible for Medicare and your employer offers a group retiree Medicare Advantage plan through Kaiser Permanente Washington, call us at 1-800-581-8252 or TTY WA Relay 711, from 8 a.m. to 5 p.m., Monday through Friday.
PEBB and FEHB members can also find information online:
Key Medicare enrollment dates
Medicare Annual Enrollment Period (AEP)
October 15 through December 7
Medicare Initial Coverage Election Period (ICEP)
65th birthday month + 3 months before and after
Medicare Advantage Open Enrollment Period (OEP)
January 1 through March 31
Other resources
Medicare Star Quality Ratings
Our Medicare Advantage health plan in Washington was rated 4.5 out of 5 stars for 2019. Our 4.5 out of 5 star rating is based on quality, service, and member satisfaction, so you get the peace of mind that comes with knowing you're getting high-quality care. 1
NCQA Quality Rating
Kaiser Permanente Washington Medicare Advantage (HMO) plan was rated 5 out of 5 in the National Committee for Quality Assurance (NCQA) Medicare Health Insurance Plan Ratings 2017-2018.2