Medicare Part C

Medicare Part C, also known as Medicare Advantage, functions similarly to Original Medicare (Part A and Part B), and depending on your specific situation and needs, those differences could be an advantage. What is Medicare Advantage? How does it work? How much does it cost? If you’re new to Medicare, keep on reading to learn more about Part C of the government-sponsored health insurance program.

Medicare Advantage

Also referred to as Medicare Advantage, Medicare Part C is essentially a combination of Original Medicare, and can also include coverage for other healthcare expenses. This single plan combines Medicare Part A (which covers hospital-related services and Medicare Part B (which covers outpatient healthcare-related services), and some options also cover additional medical care and services, such as prescription drugs, vision care, dental care, and more.

Medicare Part C policies are only available through private, Medicare-approved insurance companies. The majority of Medicare Advantage plans offer benefits that Original Medicare – Part A and Part B – don’t cover, and some Part C policies may also provide customized coverage designed to cover an individual’s specific needs; treatment for certain kinds of chronic health conditions, for example.

All Medicare Part C plans must offer a minimum of the basic services that are provided by the federal government via Original Medicare. Examples of these services might include:

• Inpatient hospital care
• Inpatient rehabilitation
• Hospice care
• Limited home-based care
• Doctor appointments
• Limited skilled nursing facility stays
• Mental health services
• Diagnostic testing, such as blood tests, lab tests, and X-rays
• Preventative health care
• Mental health screenings and care
• Durable medical equipment
• Emergency ambulance transport

On top of these basic forms of coverage that are provided under Medicare Part A and Part B, Medicare Part C plans may provide coverage for the following extra health-related services or products:

• Vision care
• Dental care
• Hearing
• Prescription drugs
• Transport to and from doctor’s appointments
• Gym membership
• Post-hospital inpatient stay-home meal delivery

It is important to note that Medicare Advantage plans are only required to cover the products and/or services that have been deemed medically necessary by the federal government under Medicare. That being said, the specific coverage that Medicare Part C plans provide varies on a case-by-case basis.

As with all parts of Medicare, as well as Medicare Supplement Insurance Plans, the out-of-pocket expenses for Medicare Advantage vary and depend on several factors. With that said, however, the majority of Part C expenses will include the following:

•       Monthly premium. The majority of Medicare Part C plans don’t charge a premium; however, that isn’t the case for all plans. In 2023, the average monthly premium for Part C (including policies that had no premium) was $18.
•         Part B premium. Medicare beneficiaries are responsible for covering the cost of the Part B premium out of their own pockets. In 2023, the monthly price for the Part B premium was $164.90; however, some Medicare Advantage plans cover a portion or all of the Part B premium.
•         Deductibles. A deductible is the amount you’ll have to pay for the medical care you receive out of your own pocket before your Medicare Part C plan will kick in and start paying for the services and/or products you receive. The deductible varies and depends on several factors.
•         Copays and coinsurance. The amount you’ll be charged when you visit a doctor either in or out of the network varies from plan to plan and depends on several factors.

The following are some of the most notable benefits that Medicare Part C provides:

•         Rather than having to deal with Part and Part B of Original Medicare as two different entities, the coverage that both of these parts of Original Medicare provides are bundled under a single plan. Additionally, you may also be able to add Medicare Part D (prescription drugs) into a Medicare Advantage plan.
•         Usually, additional benefits are available and can be grouped under Part C; vision, dental, hearing, mental health, and even food delivery after an inpatient hospital stay.
•         The cost of your out-of-pocket expenses may be lower than they would be if Part A and Part B were kept separate.
•         You will be granted all of the protections and rights that are provided under Medicare.

There are some downsides associated with Medicare Part C, as well; the following, in particular:

•         The list of in-network doctors and specialists that Part C will cover will be smaller than the list of in-network doctors and specialists under Original Medicare.
•         For some services, you might be required to get a referral or authorization, depending on the specific type of plan you have.
•         You may not be eligible for a Medicare Supplement Insurance plan (also known as Medigap) if you end up reverting to Original Medicare, or the cost of Medigap Policies could go up.

Medicare Part C is similar to standard (not government-sponsored) health insurance plans in that there are several different types of Part C plans.

Also like standard health insurance, the requirements for finding health care providers vary and depend on the specific Part C plan.

To illustrate, if your Part C plan is a preferred provider organization (PPO) plan, you’ll be able to see doctors who are both in-network and out-of-network (do note that the cost to see out-of-network doctors is usually higher).

With a health maintenance organization (HMO) Part C plan, unless it’s an emergency, you will need to see a doctor who is in your network, and a referral is required to see a specialist.

Finding the right Medicare plan doesn’t have to be confusing. Whether it’s a Medigap plan, or you have questions about Medicare Advantage or Medicare Part D, we can help.

Call us today at 1-888-891-0229 and one of our knowledgeable, licensed insurance agents will be happy to assist you!