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Medicare Part C is also known as the Medicare Advantage Program.  A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), and Medicare Medical Savings Account Plans (MSA). If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.


In HMO Plans, you can't get your health care from any doctor, other health care provider, or hospital. You generally must get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, you may be able to go out-of-network for certain services, usually for a higher cost.  This is called an HMO with a point-of-service (POS) option.


Most Plans include prescription drug coverage (Medicare Part D).  These plans are known as Medicare Advantage Prescription Drug plans (MAPD).  If you want Medicare prescription drug coverage (Part D) included in your coverage, you must join an HMO Plan that offers prescription drug coverage.


A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.


Generally, you can get your health care from any doctor, other health care provider, or hospital in PPO Plans. PPO Plans have network doctors, other health care providers, and hospitals.


Each plan gives you flexibility to go to doctors, specialists, or hospitals that aren't on the plan's list, but it will usually cost more.


Most Medicare Advantage PPO plans cover prescription drugs.  If you want Medicare drug coverage, you must join a PPO Plan that offers prescription drug coverage. Remember, if you join a PPO Plan that doesn't offer prescription drug coverage, you can't join a Medicare Prescription Drug Plan (Part D).


A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap.  The plan determines how much it will pay doctors, other health care providers, and hospitals, and howmuch you must pay when you get care.  In some cases, you get your health care from any doctor, other health care provider, or hospital in PFFS Plans.


Note:  You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to treat you. Not all providers will participate in the plans.


If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan's terms, but you may pay more.


Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.


Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network (except emergency or urgent care, such as care you get for a sudden illness or injury that needs medical care right away, or if you have End-Stage Renal Disease (ESRD) and need out-of-area dialysis). Medicare SNPs typically have specialists in the diseases or conditions that affect their members.


All SNPs must provide Medicare prescription drug coverage.


Medical Savings Account (MSA) Plans combine a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.


You may enroll in a Medicare Advantage plan when you turn 65 or first become eligible for Medicare.  You must be enrolled in Medicare Part B, and eligible for Medicare Part A.  


You may also enroll in (or change to a different) Medicare Advantage Plan during the annual enrollment period (October 15 to December 7).  Your enrollment will be effective on January 1.


There are also other special enrollment periods that someone might be eligible to use.

You may disenroll from a Medicare Advantage plan between January 1 and February 15, each year.  If you exercise this option, you may not enroll in another MA plan, but must return to traditional Medicare.


Medicare Part C 2016