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Things You Need To Know About Medicare Part C and Medicare Part D

April 19, 2012 | Comments: 0 | Views: 95

Medicare Part C is a combination of the Medicare Part A and Part B options, which are categories of the Medicare program. Medicare approved private insurance companies offer Part C, a lower cost option as opposed to the original Medicare plan and offer additional benefits, also covering Part D or prescription drug coverage to a certain extent. In brief, anyone who joins Part C will have complete access to Part A and Part B.

Medicare Part C has its own network, so all the doctors and specialists that you can consult have to be a part of the Medicare plan. Under Part C, there is a primary doctor that refers the beneficiary to medical experts and specialists. One cannot consult doctors of his/her own choice; the beneficiary has to be within the group of medical experts assigned to the plan to avail Medicare services. If one chooses to consult out of this group, the treatment or visit may prove more expensive. Under Part C one co-pays for each doctor's visit.

Part C could also be referred to as the Medicare Advantage Plans. Different insurance companies develop different kinds of Part C plans. Some may include Part D or Prescription Drugs as well. There are a number of Part C plans, and most of them include PPO, MSA, PFFS, HMO and Medicare special needs.

Medicare Preferred Provider Organisation (PPO)

In a PPO, one has the freedom to choose his/her own medical providers (doctors and specialists) out of the network. The beneficiary might have to pay out of network charges but has the freedom to see medical experts without referral.

Medicare Medical Savings Account (MSA)

Under this plan, one can either use the High Deductible Plan, which will not provide coverage until the mentioned amount of deductible is met. The other is that, Medicare provides a savings account that it manages, to its beneficiary, which has a certain sum of money deposited into it exclusively for the purpose of health care costs.

Medicare Private Fee For Service (PFFS)

Here the beneficiary can see any doctor or specialist of choice without referral only if they concur with the terms, conditions and fees of the PFFS.

Medicare Health Maintenance Organisations (HMO)

Each beneficiary has an HMO network and can choose hospital(s) and medical providers from that network alone. One might require a referral from his/her primary care physician in order to see a specialist.

Medicare Special Needs

This plan is usually for persons with special health needs and chronic illnesses. A special plan must include Part A, B and D too.

Most Part C plans should have Part D or prescription drug coverage, but if one already has a separate Part D plan then, s/he cannot buy a Part C plan with drug coverage. An individual will need to buy a Part C plan with no drug coverage.

Medicare Part D

Anyone who is eligible for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) is automatically eligible for Medicare Part D (Prescription Drugs). This means anyone who has Part D coverage gets the insurance company to pay for a section of his/her prescription medicines, regardless of the cost factor. A beneficiary who is outside the US territory and is in prison, will no longer be eligible to this section of Medicare.

Aanya, is an expert commentator on Medicare and Medicaid related information. For more information about Medicare Part C and Medicare Part D, visit

Source: EzineArticles
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