*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***

Chapter 04 - Social Security Administration (SSA) Benefits

Effective:  February 1, 2009

04.40.15 - Medicare Part C

Archived:  June 1, 2016 (Previous Versions)

Medicare Part C

Medicare Part C is known as Medicare Advantage. Most Medicare beneficiaries can choose to participate in Medicare Advantage plans, which combine Part A, Part B, and, sometimes, Part D coverage. Private insurance companies approved by Medicare manage Medicare Advantage plans. Medicare beneficiaries who do not choose Part C will continue to receive benefits under the Original Medicare Plan.





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A person may choose to enroll in a Medicare Advantage plan if he or she is:

l  Entitled to premium-free Medicare Part A (or entitled to have the Part A premium paid through the buy-in) and enrolled in Part B; and

l  Residing in the plan service area or residing outside the plan service area but was enrolled in a plan offered by the Medicare Advantage organization in the month preceding Medicare entitlement.

People with end-stage renal disease (ESRD) cannot enroll in a Medicare Advantage plan unless they developed ESRD while enrolled in a plan or in a health plan offered by the Medicare Advantage organization. A person with ESRD can enroll in a special needs plan if that plan has opened enrollment to people with ESRD.

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Medicare Advantage organizations can offer three types of plans:

l  A coordinated care plan (which includes special needs plans);

l  A combination plan that includes a Medical Savings Account (MSA) and a contribution into a medical savings account; or

l  A private fee-for-service plan.

These plans may have more coverage than Medicare, however:

l  Enrollees may have to pay an extra premium to the plan;

l  Enrollees may be limited in provider choices because they may be required to stay within a specific plan network; and

l  Enrollees who enroll in a Medicare Advantage plan that does not include Medicare Part D, must enroll in a stand-alone Part D plan or they will not have Medicare drug coverage.

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Medicare Part C does not require enrollees to pay a premium in addition to the Part A and Part B premiums, however:

l  A Medicare Advantage Plan may provide additional benefits and charge an additional premium.

l  Medicare Part A and Part B premiums will continue to be deducted from the person’s monthly Social Security or Railroad Retirement benefits.

l  Medicare Part D premiums will continue to be paid using the method the enrollee chooses.

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Medicare beneficiaries can choose to enroll in a Medicare Advantage plan during:

l  Their initial enrollment period.

l  The annual election period.

During  the annual election period, a person can change from a Medicare Advantage plan back to Original Medicare, to a different Medicare Advantage plan, or from Original Medicare to a Medicare Advantage plan. A person who switches from a Medicare Advantage plan to Original Medicare must also enroll in a Medicare Part D plan to continue prescription drug benefits.

l  Open enrollment.  

During open enrollment, a person who is not enrolled in a Medicare Advantage plan may enroll in a plan. A person enrolled in a Medicare Advantage plan with Part D coverage may switch to another Medicare Advantage plan with Part D coverage or to Original Medicare and a Medicare Part D plan. For new Medicare beneficiaries, open enrollment begins the month they qualify for both Medicare Parts A and B and runs for three months or through December 31 of that year, whichever is earlier.

l  A special enrollment period.

A special enrollment period may be granted due to special circumstances, such as when a person becomes enrolled in Medical Assistance (MA), has a change in residence and moves outside the Medicare Advantage plan’s service area, or has another change that is determined by CMS to warrant a special enrollment.

See Medicare for more information about these enrollment periods.

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