Who Qualifies for the Medicare Supplement Plan C?


Quick Answer

Medicare Part C, also known as Medicare Advantage, is available to those who already have Medicare Parts A and B coverage and live in the service area of the plan they are interested in joining. Those who have end-stage renal disease are not eligible to enroll in Medicare Part C.

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Full Answer

Medicare Part C coverage consists of alternative health plans offered by private insurance companies. Advantage plans must offer all the coverage provided by Medicare Parts A and B. Additionally, they usually offer prescription drug coverage and sometimes offer other services, such as dental, hearing, vision, and health and wellness programs. Only hospice care is still covered by original Medicare when patients are in Medicare Advantage programs. Those in Medicare Part C pay an additional Medicare Advantage premium as well as their regular Medicare Part B premium.

Medicare Advantage plans typically have networks of doctors and other health care providers that patients must visit to maintain coverage. If it is necessary to see specialists outside the network, patients must have a referral from a doctor within the network or risk paying the entire fee out of pocket. The initial seven-month enrollment period for Medicare Part C is three months before the month of the 65th birthday, that month and three months after. Following the initial enrollment period, individuals can switch from Medicare Parts A and B to a Medicare Part C plan only during the open enrollment period, which was October 15 to December 7 in 2014.

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