Medicare part C (USA) : Questions médicales fréquentes
Nom anglais: Medicare Part C
Descriptor UI:D020398
Tree Number:N03.706.615.420.249
Questions fréquentes et termes MeSH associés
Diagnostic
5
#1
Comment savoir si je suis éligible au Medicare Part C ?
Vous devez être inscrit au Medicare Part A et B et résider dans la zone de couverture.
MedicareAssurance santé
#2
Quels documents sont nécessaires pour s'inscrire ?
Un numéro de sécurité sociale, une preuve de résidence et des informations sur votre santé.
Documents médicauxInscription
#3
Quand puis-je m'inscrire au Medicare Part C ?
L'inscription se fait pendant la période d'inscription ouverte, généralement en automne.
Période d'inscriptionMedicare
#4
Y a-t-il des tests de santé requis ?
Aucun test spécifique n'est requis, mais des évaluations de santé peuvent être demandées.
Évaluation de santéTests médicaux
#5
Comment vérifier les plans disponibles dans ma région ?
Utilisez le site Medicare ou contactez un conseiller en assurance santé.
Plans d'assuranceRessources Medicare
Symptômes
5
#1
Quels symptômes indiquent un besoin de Medicare Part C ?
Des besoins médicaux croissants ou des coûts de santé élevés peuvent justifier l'inscription.
Besoins médicauxCoûts de santé
#2
Le Medicare Part C couvre-t-il les soins préventifs ?
Oui, il couvre de nombreux services préventifs sans frais supplémentaires.
Soins préventifsCouverture Medicare
#3
Quels types de soins sont souvent couverts ?
Les soins hospitaliers, les visites chez le médecin et les médicaments sur ordonnance.
Soins hospitaliersMédicaments sur ordonnance
#4
Y a-t-il des symptômes d'une couverture insuffisante ?
Des factures médicales élevées ou des refus de soins peuvent indiquer une couverture insuffisante.
Factures médicalesCouverture d'assurance
#5
Comment savoir si mon plan couvre mes médicaments ?
Vérifiez le formulaire de médicaments de votre plan ou contactez le service client.
Formulaire de médicamentsService client
Prévention
5
#1
Quels services préventifs sont offerts ?
Vaccins, dépistages et examens de santé réguliers sont souvent couverts.
Services préventifsDépistages
#2
Comment le Medicare Part C aide-t-il à la prévention ?
Il offre des services sans frais pour encourager les soins préventifs et le dépistage.
PréventionSoins de santé
#3
Les programmes de bien-être sont-ils inclus ?
Oui, de nombreux plans incluent des programmes de bien-être et de gestion de la santé.
Programmes de bien-êtreGestion de la santé
#4
Comment accéder aux services préventifs ?
Prenez rendez-vous avec votre médecin ou un fournisseur de soins de santé dans le réseau.
Accès aux soinsRendez-vous médical
#5
Y a-t-il des limites sur les services préventifs ?
Les limites varient selon le plan; consultez votre document de couverture pour plus de détails.
Limites de couvertureServices préventifs
Traitements
5
#1
Quels traitements sont couverts par Medicare Part C ?
Les traitements hospitaliers, les soins ambulatoires et certains services de santé mentale.
Traitements médicauxSoins ambulatoires
#2
Le Medicare Part C couvre-t-il les soins dentaires ?
Cela dépend du plan; certains offrent une couverture dentaire supplémentaire.
Soins dentairesCouverture dentaire
#3
Comment choisir un plan Medicare Part C ?
Comparez les coûts, les couvertures et les réseaux de fournisseurs disponibles.
Choix de planComparaison d'assurance
#4
Les soins de santé mentale sont-ils couverts ?
Oui, la plupart des plans Medicare Part C couvrent les soins de santé mentale.
Santé mentaleCouverture des soins
#5
Y a-t-il des traitements non couverts ?
Certains traitements expérimentaux ou non approuvés peuvent ne pas être couverts.
Traitements expérimentauxNon couvert
Complications
5
#1
Quelles complications peuvent survenir avec Medicare Part C ?
Des frais imprévus ou des restrictions de réseau peuvent poser des problèmes.
Frais médicauxRestrictions de réseau
#2
Comment gérer les complications de couverture ?
Contactez le service client de votre plan pour résoudre les problèmes de couverture.
Gestion des complicationsService client
#3
Les complications de santé sont-elles couvertes ?
Oui, les complications de santé liées à des conditions couvertes sont généralement prises en charge.
Complications de santéCouverture d'assurance
#4
Que faire en cas de refus de soins ?
Vous pouvez faire appel de la décision auprès de votre assureur ou du Medicare.
Refus de soinsAppel d'assurance
#5
Les complications financières sont-elles fréquentes ?
Certaines personnes rencontrent des frais imprévus; il est important de bien comprendre son plan.
Complications financièresFrais imprévus
Facteurs de risque
5
#1
Quels facteurs influencent l'éligibilité au Medicare Part C ?
L'âge, le statut de citoyen et l'inscription à Medicare Part A et B sont déterminants.
ÉligibilitéFacteurs de risque
#2
Les antécédents médicaux affectent-ils l'inscription ?
Non, les antécédents médicaux ne peuvent pas affecter votre éligibilité au Medicare Part C.
Antécédents médicauxInscription
#3
Y a-t-il des risques liés à la sélection d'un plan ?
Choisir un plan inadapté peut entraîner des coûts élevés ou une couverture insuffisante.
Sélection de planRisques financiers
#4
Comment les changements de santé affectent-ils le plan ?
Des changements de santé peuvent nécessiter une réévaluation de votre plan Medicare Part C.
Changements de santéRéévaluation de plan
#5
Les changements de revenus influencent-ils l'éligibilité ?
Oui, des changements de revenus peuvent affecter les primes et les coûts des soins.
Changements de revenusÉligibilité
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},
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},
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"position": 18,
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"position": 20,
"acceptedAnswer": {
"@type": "Answer",
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}
},
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"name": "Quelles complications peuvent survenir avec Medicare Part C ?",
"position": 21,
"acceptedAnswer": {
"@type": "Answer",
"text": "Des frais imprévus ou des restrictions de réseau peuvent poser des problèmes."
}
},
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"position": 22,
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"text": "Contactez le service client de votre plan pour résoudre les problèmes de couverture."
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"@type": "Question",
"name": "Les complications de santé sont-elles couvertes ?",
"position": 23,
"acceptedAnswer": {
"@type": "Answer",
"text": "Oui, les complications de santé liées à des conditions couvertes sont généralement prises en charge."
}
},
{
"@type": "Question",
"name": "Que faire en cas de refus de soins ?",
"position": 24,
"acceptedAnswer": {
"@type": "Answer",
"text": "Vous pouvez faire appel de la décision auprès de votre assureur ou du Medicare."
}
},
{
"@type": "Question",
"name": "Les complications financières sont-elles fréquentes ?",
"position": 25,
"acceptedAnswer": {
"@type": "Answer",
"text": "Certaines personnes rencontrent des frais imprévus; il est important de bien comprendre son plan."
}
},
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"text": "L'âge, le statut de citoyen et l'inscription à Medicare Part A et B sont déterminants."
}
},
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"name": "Les antécédents médicaux affectent-ils l'inscription ?",
"position": 27,
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}
Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, 601E Ford Bldg, University Park, PA 16801. Email: kuj11@psu.edu.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House 302, Baltimore, MD 21205. Email: sparasr4@jhu.edu.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Carey Business School, Hopkins Business of Health Initiative, Baltimore, Maryland, USA.
Financial incentives in Medicare Advantage (MA), the managed care alternative to traditional Medicare (TM), were designed to reduce overutilization. For patients near the end of life (EOL), MA incenti...
To compare receipt of potentially burdensome treatments and transfers and potentially necessary postacute services in the last 6 months of life in individuals with MA vs TM....
A retrospective analysis of Medicare claims data among older Medicare beneficiaries who died between 2016 and 2018. The study included Medicare decedents aged 66 years or older covered by TM (n = 659 ...
MA enrollment....
Receipt of potentially burdensome hospitalizations and treatments; receipt of postdischarge home and facility care....
The study included 659 135 TM enrollees (mean [SD] age at death, 83.3 [9.0] years, 54% female, 15.1% non-White, 55% with 1 or more life-limiting condition) and 360 430 MA enrollees (mean [SD] age at d...
MA enrollment was associated with lower rates of potentially burdensome and facility-based care near the EOL. Greater use of home-based care may improve quality of care but may also leave patients wit...
A growing proportion of the population is enrolling in Medicare Advantage (MA), which typically offers additional benefits compared with traditional Medicare (TM)....
To determine whether frailty and frailty trajectories differ between MA enrollees and TM enrollees....
This retrospective cohort study used data from the National Health and Aging Trends Study (2015-2016). Analyses were conducted from August 2023 to March 2024. Participants were community-dwelling Medi...
Enrollment in MA vs TM....
Frailty was calculated by a frailty index (FI) (range, 0-1, with higher values indicating greater frailty) and the Fried Frailty Phenotype (FFP) score (range, 0-5, with higher values indicating greate...
The final cohort consisted of 7063 participants (2775 [23.1%] aged >80 years; 4040 [54.7%] female), representing a sample of the 38.8 million beneficiaries. There were 2583 (35.0%) MA enrollees (13.6 ...
In this cohort study of Medicare beneficiaries from 2015, MA enrollees experienced similar declines in frailty over 1 year compared with TM enrollees. Future work should examine whether the specific t...
Compared with traditional Medicare (TM), Medicare Advantage (MA) insurers have greater financial incentives to reduce the delivery of low-value services (LVS); however, there is limited evidence at a ...
To determine whether there are differences in the rates of LVS delivered to Medicare beneficiaries enrolled in MA vs TM, overall and by the 7 largest MA insurers....
This cross-sectional study included Medicare beneficiaries aged 65 years and older residing in the US in 2018 with complete demographic information. Eligible TM beneficiaries were enrolled in Parts A,...
Medicare plan type....
The primary outcome was utlization of 35 LVS defined by the Milliman Health Waste Calculator. An overdispersed Poisson regression model was used to calculate estimated margins comparing risk-adjusted ...
The study sample included 3 671 364 unique TM beneficiaries (mean [SD] age, 75.7 [7.7] years; 1 502 631 female [40.9%]) and 2 299 618 unique MA beneficiaries (mean [SD] age, 75.3 [7.3] years; 983 592 ...
In this cross-sectional study of nearly 6 million Medicare beneficiaries, utilization of LVS was on average lower among MA beneficiaries compared with TM beneficiaries, possibly owing to stronger fina...
Unlike traditional Medicare (TM), Medicare Advantage (MA) plans limit in-network care to a specific network of Medicare clinicians. MA plans thus play a role in sorting patients to a subset of clinici...
To examine whether avoidable hospital stay differences between MA and TM can be explained by the primary care clinicians who treat MA and TM beneficiaries....
This was a cross-sectional study of a nationally representative sample of MA and TM beneficiaries in 2019 with any of 5 chronic ambulatory care-sensitive conditions (ACSCs). The relative risk (RR) of ...
Enrollment in MA....
Whether a beneficiary had avoidable hospital stays in 2019 due to any of the ACSCs. Avoidable hospital stays included both hospitalizations and observation stays....
The study sample comprised 1 323 481 MA beneficiaries (mean [SD] age, 75.4 [7.0] years; 56.9% women; 69.3% White) and 1 965 863 TM beneficiaries (mean [SD] age, 75.9 [7.4] years; 57.1% women; 82.5% Wh...
In this cross-sectional study of MA and TM beneficiaries, the lower rate of avoidable hospital stays among MA beneficiaries than TM beneficiaries was attributable to MA beneficiaries visiting clinicia...
Better evidence is needed on whether Medicare Advantage (MA) plans can control the use of postacute care services while achieving excellent outcomes....
To compare self-reported use of postacute care services and outcomes among traditional Medicare (TM) beneficiaries and MA enrollees....
This cohort study used data from the National Health and Aging Trends Study (NHATS) with linked Medicare enrollment data from 2015 to 2017. Participants were community-dwelling MA or TM beneficiaries ...
Enrollment in MA and dual eligibility for Medicare and Medicaid....
Postacute care service use including site of use, duration, primary indication, and whether participants met their goals or experienced improved functional status during or after services....
Included in the analysis were 2357 Medicare beneficiaries who used postacute care. Of these beneficiaries, 815 (32.6%; 62.0% were females [weighted percentages]) had MA and 1542 (67.4%; 59.5% were fem...
In this cohort study of Medicare beneficiaries, we found that MA enrollees overall used less postacute care services than their TM counterparts. Among users of postacute care services, MA enrollees re...
Limiting the use of high-risk medications (HRMs) among older adults is a national priority to provide a high quality of care for older beneficiaries of both Medicare Advantage and traditional fee-for-...
To evaluate the differences in the rate of HRM prescription fills among beneficiaries of traditional Medicare vs Medicare Advantage Part D plans and to examine the extent to which these differences ch...
This cohort study used a 20% sample of Medicare Part D data on filled drug prescriptions from 2013 to 2017 and a 40% sample from 2018. The sample comprised Medicare beneficiaries aged 66 years or olde...
The primary outcome was the number of unique HRMs prescribed to older Medicare beneficiaries per 1000 beneficiaries. Linear regression models were used to model the primary outcome, adjusting for pati...
The sample included 5 595 361 unique Medicare Advantage beneficiaries who were propensity score-matched on a year-by-year basis to 6 578 126 unique traditional Medicare beneficiaries between 2013 and ...
Results of this study showed that HRM rates were consistently lower among Medicare Advantage than traditional Medicare beneficiaries. Higher use of HRMs among female, American Indian or Alaska Native,...
To compare racial and ethnic disparities in cost-related medical care and dental care barriers and use of vision care among near-poor Medicare beneficiaries in Medicare Advantage (MA) vs traditional M...
Cross-sectional analysis of 2015-2019 data from the nationally representative Medicare Current Beneficiary Survey....
Propensity score-weighted difference-in-disparities analyses comparing Black-White and Hispanic-White disparities in MA vs TM among near-poor Medicare beneficiaries with incomes between 101% and 250% ...
For cost-related barriers to medical care, Hispanic-White disparities were narrower by 8.8 (95% CI, -14.0 to -3.6) percentage points in MA relative to TM but differences in Black-White disparities wer...
Among near-poor Black and Hispanic Medicare beneficiaries, MA was associated with greater use of vision care and narrowing of some disparities in cost-related access barriers vs TM. However, MA did no...
To assess the validity of race/ethnicity coding in Medicare data and whether misclassification errors lead to biased outcome reporting by race/ethnicity among Medicare Advantage beneficiaries....
In this national study of Medicare Advantage beneficiaries, we analyzed individual-level data from the Health Outcomes Survey (HOS) and the Consumer Assessment of Healthcare Providers and Systems (CAH...
We used self-reported beneficiary race/ethnicity to validate the Medicare Enrollment Database (EDB) and Research Triangle Institute (RTI) race/ethnicity codes. We measured the sensitivity, specificity...
Data for Medicare Advantage beneficiaries who completed either the HOS or CAHPS survey were linked to MBSF and MedPAR files. Validity was assessed for both self-reported multiracial and single-race be...
For beneficiaries enrolled in Medicare Advantage, the EDB and RTI race/ethnicity codes have high validity for identifying non-Hispanic White or Black beneficiaries, but lower sensitivity for beneficia...
Current Medicare race/ethnicity codes misclassify and bias outcomes for non-Hispanic AIAN beneficiaries, who are more likely to select multiple racial identities. Revisions to race/ethnicity categorie...
In 2019 and 2020, Medicare Advantage (MA) plans received historic flexibility to begin to address members' nonmedical and social needs through a set of primarily health-related benefits (PHRBs) and Sp...
A difference-in-differences design of retrospective Medicare enrollment data linked to publicly available plan and county-level data....
We linked individual-level Medicare enrollment data to publicly available, plan-level MA benefit, crosswalk, and penetration files from 2016 to 2020. We compared the number of new enrollees and the pr...
In fully adjusted models, PHRB adoption was associated with a 2.2% decrease in the proportion of fully dual-eligible new members (95% CI, -4.0% to -0.5%). SSBCI adoption was associated with a 2.3% dec...
We determined that supplemental benefit adoption was not associated with demographic shifts in MA plan enrollment....
Commercial health insurers can participate in the rapidly growing Medicare Advantage (MA) market, which may affect network formation and prices in traditional commercial insurance markets. We aim to q...
Repeated cross-sectional analysis of Clarivate's Interstudy enrollment data comprising the universe of insurers in the United States from 2015 to 2021....
We calculated the share of employer-sponsored insurance (ESI) enrollees covered by an insurer offering MA in their state in 2015, 2017, 2019, and 2021. We documented this share across states, years, a...
Between 2015 and 2021, the share of ESI enrollees covered by an insurer offering MA in the same state increased from 83.5% to 95.3%. This growth was concentrated in states with initially low rates in ...
By 2021, almost all ESI enrollees were covered by insurers who participated in MA in the same state. Future research should investigate how insurer participation in MA affects network formation and pr...
