What is Medicare Part C?
Medicare Part C, also called Medicare Advantage, is an additional insurance option for people enrolled in Original Medicare.
Original Medicare includes Part A (Hospital) and Part B (Medical) coverage.
Medicare Part C offers coverage for Parts A and B, plus extra services like prescription drugs, dental, vision, and more.
In this article, we explore what Medicare Part C offers, how much it costs, and how to choose the best plan for your situation.
Do you need Medicare Part C?
Medicare Part C is additional coverage that Medicare offers through private insurance companies. With this plan, you can get coverage for prescription drugs, dental and vision services, as well as other health-related services.
WHAT MEDICARE PART C COVERS
With the correct Medicare Part C benefits you will have the following coverage:
- hospital services, nursing facility care, home health care, and hospice care
- medical services related to the prevention, diagnosis, and treatment of medical conditions
- mental health problems
- prescription drug coverage
- dental, vision, and hearing services
- optional health services, such as gym memberships
If you need more than basic hospital and medical insurance, Medicare Part C is an essential coverage option.
Are you eligible to enroll in Medicare Part C?
You qualify for Medicare Part C if you already have Parts A and B, and if you live in the service area of the Medicare Part C provider you’re considering.
It’s important to note that even if you meet these two requirements, people with End-Stage Renal Disease generally don’t qualify for Medicare Part C.
WHAT YOU NEED TO KNOW TO ENROLL IN MEDICARE
- Enrollment in Medicare must be done within a certain time and should start approximately 3 months before your 65th birthday. You can also apply for Medicare in the month you turn 65 and for 3 months after your 65th birthday, although your coverage date will be delayed.
- If you miss Medicare’s initial enrollment period, open enrollment runs from January 1 to March 31 of each year.
- If you enroll during the late enrollment period, you may incur additional late fees and may not receive any coverage until July 1, which may leave you with a coverage gap.
- To sign up for Medicare: You can sign up online by going to the Social Security website.
- To enroll in Medicare Part C: You can shop for Medicare Part C plans online at Medicare.gov.
What Medicare Part C plans are available?
The Medicare Tool is the easiest way to find out what Medicare Part C plans are available. Find a 2020 Medicare plan.
Based on your answers to certain questions, the tool will select companies that offer Medicare Part C plans that fit your needs. This Medicare tool helps compare plans in your area.
A quick Google search for “Medicare Advantage plans in (insert your city, state, or zip code)” can also narrow down which companies offer Medicare Advantage plans in your city and state.
Another major insurance company that covers you may offer Medicare Part C plans. Some of the major insurance companies that offer Medicare Part C are:
- kaiser permanent
Medicare Advantage HMO Plans
HMO, or health maintenance organization, plans are a popular option for those who want additional coverage not offered by Original Medicare. You can get care from your Medicare Advantage HMO plan’s network health care providers, but you’ll need to get a referral to see a specialist.
There are many options for Medicare Advantage HMO plans in every state, including plans with $0 premiums, no deductibles, and low copays. To join a Medicare Advantage HMO plan, you must already be enrolled in Original Medicare.
Medicare Advantage PPO Plans
PPO, or Preferred Provider Organization, plans are the most popular health care plan option for additional coverage. This type of plan allows a greater level of freedom for buyers.
With a PPO plan, you can go to your preferred doctors, specialists, and health care facilities, whether or not they are part of your plan’s network. However, PPO plans to charge different rates based on a list of in-network or out-of-network providers.
PPO plans are also convenient because you don’t need a referral to see a specialist.
How much does Medicare Part C cost?
There are a variety of costs associated with a Medicare Part C plan, which means your out-of-pocket costs could vary.
Some Medicare Part C plans will cover a portion of your monthly Part B premium. However, some of these plans also have their premium and deductible.
In addition to these costs, you may also have to pay a copay at the time you receive services.
OTHER FACTORS THAT INFLUENCE THE COST
Other factors that influence the cost of a Medicare Part C plan include:
- the type of plan you choose, such as HMO, PPO, PFFS, SNP, or MSA
- your income, which can be used to determine your premium or deductible amount
- your percentage of costs
- how often do you need medical services?
- whether the medical services are received in or out of network
- if you receive other financial assistance, such as Medicaid
There are many advantages to having Medicare Part C, including an annual limit on how much you’ll pay out of pocket. Still, those upfront costs can add up over time before you reach that limit, so it’s important to consider all factors when choosing a Medicare Part C plan.
What are the other parts of Medicare?
Medicare Part C is different from other plans that Medicare offers. The other parts of Medicare coverage are known as Part A, Part B, Part D, and Medigap.
Part A (hospital insurance)
This insurance covers hospital-related services, such as emergency room visits or hospital care. Home health care, nursing, and hospice services are also included in Medicare Part A. Medicare Part A are included in a Medicare Part C plan.
Part B (medical coverage)
This insurance covers preventive medical care, as well as services for the diagnosis and treatment of medical conditions. Medical transportation costs are also included in this coverage. Medicare Part B is included in a Medicare Part C plan.
Part D (prescription drugs)
This prescription drug coverage is generally best used as a supplement to Original Medicare for people who are not interested in Medicare Part C. It can also be added as coverage for a Medicare Advantage plan that doesn’t cover prescription drugs.
Medigap (supplemental insurance)
Medigap and Medicare Part C are different. Medigap is supplemental coverage to what you already have with Medicare, while Medicare Part C covers all of your Medicare benefits. Medigap is a good option if you’re happy with your Medicare coverage, but would like supplemental insurance.
If you don’t need Medicare Part C
If you’re happy with your current Medicare coverage and only want prescription drug coverage, Medicare Part D might be enough.
If you have Medicare coverage but just need extra help with costs, a Medigap policy might be right for you.
For some people, Medicare Part C represents an additional cost that they simply cannot afford; In this case, shopping around for Part D and Medigap coverage can help save money.