Who Is Eligible for Medicare Part C Coverage?


Quick Answer

Individuals who have Medicare Part A and B, who live in the provider's service area, and who do not have End-Stage Renal Disease are generally eligible to enroll in a Medicare Part C, states Medicare.gov. Each year individuals may make changes or enroll in Medicare plans during the enrollment periods.

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Full Answer

Medicare Part C is also known as Medicare Advantage, according to Medicare.gov. It is a type of Medicare plan under which a private insurance company contracts with the government to provide Medicare health insurance benefits directly to individuals eligible for them. Insurance plans available under Medicare Part C include HMOs, PPOs, special-needs plans, private fee-for-service plans and medical savings account plans. When enrolled in a Medicare Advantage plan, an individual's covered medical services are paid for by the private insurance rather than by the government through traditional Medicare.

There are a number of advantages and disadvantages to consider prior to deciding whether or not to enroll in an Medicare Advantage plan, according to Senior65. Some of the advantages include lower premium costs, a single premium payment, and the fact that most Medicare Advantage plans include prescription drug coverage. Additionally, many Medicare Advantage plans include extra benefits, such as gym memberships, which are not included in traditional Medicare. Disadvantages that may come with Medicare Advantage plans may include smaller networks of doctors and hospitals, potential gaps in coverage for serious medical issues, and lack of nationwide networks. Also, although Medicare Advantage plans must technically cover everything that traditional Medicare covers, the private insurer may choose how it covers them.

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