Medicare Part C

Part C – Advantage Plans

Medicare Advantage Plans are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans include :

    • Health Maintenance Organizations (HMOs)
    • Preferred Provider Organizations (PPOs)
    • Private Fee-for-Service Plans
    • Special Needs Plans
    • Medicare Medical Savings Account Plans

Part C seldom covers RNHCIs

As a general rule, Part C Advantage Plans do not cover RNHCIs.

These plans do not usually or consistently reimburse for stays at RNHCIs because the BA is not a contracted provider for Medicare HMOs, and there are no billing codes established for HMOs at this time.

The Cost

Each year, plans establish the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan may change only once a year, on January 1.

Click here to find out what your out-of-pocket costs depend on at medicare.gov.

IF YOU DO HAVE PART C – AN ADVANTAGE PLAN

  1. Read your plan carefully to ensure coverage of RNHCIs and Christian Science benefits-should have something in writing. (Our experience for 25 years is an advantage plan seldom covers Christian Science nursing & RNHCIs).
  2. Requires a pre-authorization for admittance (except emergencies)
  3. Ask if your local Christian Science facility is in network. Can they be?
  4. Contact us if you have specific questions.