Medicare Part C
Medicare Part C or Medicare Advantage is coverage from a private company. Location is the most significant factor in plan availability. Some areas have many options, while other regions may have none.
These plans can offer an array of benefits ranging from dental, vision, hearing, and gym memberships. Many Part C plans have a $0 premium, so it’s easy to see what attracts people to these plans.
But, even with all the perks, there are downfalls to Medicare Advantage.
Below we discuss all the things you need to know about Part C.
What is Medicare Part C
Medicare Part C is an Advantage plan. When you choose Advantage, a private company will handle your benefits and claims instead of Medicare.
Part C must cover at least as good as Medicare unless you go out of the network. Those with a Health Maintenance Organization policy will pay 100% out of pocket when they leave the network.
But, if you have a Preferred Provider Organization plan, there will be some coverage. In some cases, you pay 40% of the cost out of the network.
Also, there are Health Maintenance Organization Point of Service policies that allow you to see some doctors out of network at a higher rate.
The Private Fee for Service policies require you to call the doctor before services are rendered to ensure coverage is still available, you must do this EVERY time before an appointment.
For those that have low-income or chronic issues, Medicare Advantage Special Needs plans can help. But, you must live in the service area of the plan to qualify.
What Does Medicare Part C Cover
Part C must cover all services that have coverage under Part A and Part B. Most plans include more than Medicare.
Any Medicare Advantage policy will cover:
- Hospitalization in a semi-private room
- Doctor visits
- Outpatient services
- Tests, including blood tests, X-rays, CT Scans and MRIs
- Emergency room visits
- The cost of durable home health equipment like oxygen and walkers
Also, many Part C plans cover preventive care and prescription drugs; some offer dental and vision benefits.
If you’re in a Private-Fee for Service (PFFS) plan without drug coverage, you can add drug coverage by enrolling in a Part D plan.
You can also get vision and dental through independent insurance. But, you can’t have both Medigap and Advantage at the same time.
Medicare Part C Plans 2020
More than 20 million beneficiaries have a Medicare Advantage plan. In 2020, there are over 3,100 Part C options across the nation.
Almost all beneficiaries have access to a Part C plan that covers extra benefits that Medicare won’t cover. Over 90% of Advantage plans include transportation assistance, and over 95% cover a meal benefit.
Also, some plans include telehealth services or in-home support. Some states like Pennsylvania, Wisconsin, Florida, Minnesota, and Oregon have over 40% of beneficiaries in an Advantage plan.
But, just because everyone else is doing it, doesn’t mean it’s best for you. There is a reason people talk about “why Medicare Advantage plans are bad.”
Before you choose your policy, compare Medigap and Advantage, so you know you’re getting the best value for you.
Medicare Part C and Eligibility
You must have Both Part A and Part B to be eligible for Part C. There is no age requirement, Part C is mostly available to anyone. There is one factor that could hinder your eligibility.
The one health question that can disqualify you for a Medicare Advantage plan is, “do you have End-Stage Renal Disease?” Unless you develop End-Stage Renal Disease when you’re already on a Medicare Advantage plan, you won’t be able to select this coverage.
If you already have Medicare Advantage when you develop ESRD, you might be able to select a different plan with the same company. Also, if the plan leaves the area, you’ll have a one-time right to choose another policy.
Further, if an ESRD Special Needs Plan is available in your area, you may join. Also, if you have a successful kidney transplant and no longer have ESRD, you’ll qualify for Medicare Advantage coverage.
CMSnewsroom claims ESRD patients will have access to Medicare Advantage plans by 2021 or 2022.
Differences Between Part C Medicare and Original Medicare
Under Part A and B, there are no provider networks; so, you can go to any doctor or hospital you want, so long as they accept Medicare.
Private insurance companies offer Part C through HMOs and PPOs. For each, there’s a list of “in-network” healthcare providers.
If you go to a provider out of the network, your claim may not have coverage, or you’ll pay more for services.
By comparing Medicare Advantage vs. Medicare Supplement side by side, you can figure out which you prefer.
How Much Does Part C Cost
Many Advantage plans have a $0 premium. But, some areas have a higher premium costing plan.
The average Medicare Advantage plan cost is about $23 a month in 2020. Of course, your location is the determining factor in the plans available to you.
When you live somewhere that has little to now quality plan options, consider the benefits of Medigap.
Tip: Getting a quote for Medigap is free, call an agent today for your price estimate!
How to Pay for Medicare Part C
Like most insurance, Medicare Advantage plans allow you to pay by phone or by mail. Some companies may have an online payment feature.
It’s best to discuss payment with the agent before submitting your application. Different plans may have different payment methods.
Often, plans offer discounts if you pay a year upfront or if the premium is an automatic deduction from a bank.
Making Part C Late Payments
Sometimes life can get in the way, and you fall behind with your Medicare Advantage plan.
Medicare has several options when it comes to late and missed payments, and it’ll be up to your policy to choose how they handle it.
Below are Medicare’s rules regarding payments:
- Continued receipt of coverage
- Provide you with a grace period and warning of dis-enrollment, followed by dis-enrollment
- Advise you via a letter to contact your health plan to resolve
You must always first obtain a notice before a policy can drop coverage. Grace periods can range in length but must be at least two months.
The grace period depends on your policy. The grace periods begin on the first day that the premium has not been paid.
What happens if you find yourself disenrolled
Single Grace Period – If one or more payments have gone unpaid during your grace period, the plan can discontinue coverage.
Rollover Grace Period – If you owe more than one premium but manage to pay for a minimum of one premium during your grace period, the period will end, and your plan will notify you of a new grace period.
Notifications continue until you catch up on premiums. But, if you fail to make a premium payment during this time, you face dis-enrollment.
Medicare Part C FAQ’s
Why Do I Need Part C?
Part C must offer at least the same health benefits as Medicare; but, they usually include better coverage. Also, Part C plans can cover ancillary benefits, such as routine dental, vision, and hearing.
But, beneficiaries should consider purchasing extra coverage since this isn’t a comprehensive benefit.
Not all plans provide drug coverage. It’s essential to check your formulary and make sure your pharmacy is in-network.
You don’t need Part C; if you choose to enroll in a Medicare Advantage plan, you can’t join in a Medigap plan.
How is Advantage Part C Funded?
Upon agreeing to pay your claims, the Medicare Advantage plan receives funding from the government. So, instead of Medicare worrying about paying your claim, it’s the responsibility of the Part C insurer.
Some plans also request you to make premium payments. Depending on where you live, the cost of and Advantage plan could be higher than in other areas.
Is Medicare Part C Going Away in 2020?
No, Part C isn’t going away, but Medigap Plan C won’t be available to those eligible for Medicare in 2020 or after. Yet, those eligible for Medicare before 2020, can enroll in Plan C.
All first-dollar coverage plans will be eliminated for those “newly eligible beneficiaries.” Medicare Advantage plans ARE NOT first-dollar coverage.
Is Medicare Part C the Same as Supplement Insurance?
No, Medicare Supplement plans work with Medicare to provide you the most comprehensive policy. A Medigap plan will cover the 20% that Medicare doesn’t cover.
While the advantage plan will find a different way to charge you, but still give you coverage.
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