Medicare Part C

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Once enrolled in both parts of Original Medicare, you can elect to enroll in Part C Medicare. It’s important to educate yourself on the different types of Medicare Part C plans.

Understand Medicare Advantage coverage, eligibility, limitations and the costs associated with these policies. Many seniors ask: “What is Part C of Medicare?”; well, discover the details below!

What is Medicare Part C

Medicare Part C, or “Medicare Advantage,” is Medicare coverage offered by a private insurance company. Part C is sometimes considered an all in one Medicare Plan.

Beneficiaries can sign up for Medicare Advantage instead of Original Medicare Parts A and B and a Medigap policy. All Advantage plans offer Part A and B benefits, but many have additional coverage.

Advantage plans can be PPOs, HMOs, PFFS, SNP, HMP-POS or MSA and they operate much like employer health insurance coverage.

What Does Medicare Part C Cover

Medicare Part C definition states that these policies must cover all medically necessary services that are covered under Part A (hospitals) and Part B (medical expenses).

This means that any 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

Many Part C Medicare plans also 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 prescription drug coverage separately by enrolling in a standalone Medicare Part D prescription drug plan.

You can also get vision and dental coverage through independent insurance.

However, if you enroll in Medicare Advantage, you cannot get Medicare Medigap plans to cover the things that Medicare Advantage Part C coverage does not.

Differences Between Part C Medicare and Original Medicare

Under Original Medicare Parts 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 Medicare Part C coverage through HMOs and PPOs. For each, there’s a list of “in-network” healthcare providers.

If you go to a provider who is not in the network, your claim may not be covered (especially if you join an HMO), or you will usually pay more for the out of network doctor’s services.

You can find more frequently asked questions regarding Medicare Advantage vs Medicare Supplement here.

How Much Does Part C Cost

There are two components to your Part C premium: Medicare Parts A and B coverage, and additional coverage offered by your Part C plan.

Part A coverage is free for most people, and the standard Medicare Part B premium is $135.50 (though your premium may be more or less than this).

You’ll pay this same Part B premium if you have a Part C plan, but you may also pay an additional premium to cover the other benefits your plan offers.

Premiums may vary widely, depending on the plan you choose and the state you live in.

Part C plans are much less standardized than Original Medicare or Medigap, and that means your out of pocket costs will also depend on the plan you choose and the state you live in.

Different plans have different co-pays, deductibles, out of pocket maximums and rules about in-network vs out of network providers. That’s why it’s important to be informed and shop around when looking for Part C coverage.

Who is Eligible for Part C

You can sign up for a Part C Medicare during the Annual Enrollment Period or you’re personal Initial Enrollment Period. During those times your eligible for Medicare Advantage.

The Initial Enrollment Period begins three months before the month you turn 65 and ends three months after the month you turn 65.

The Annual Enrollment Period is every year from October 15 to December 7th. During this time, you’re free to change your Advantage plan, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage to Original Medicare.

There is also a second Open Enrollment Period specifically for switching from Medicare Advantage to Original Medicare and adding prescription drug coverage. That period runs from January 1 to February 14th each year.

Why Do I Need Part C

Medicare Part C must offer at least the same health benefits as Traditional Medicare; however, they usually include slightly better coverage.

Part C plans occasionally cover ancillary benefits; such as routine dental, vision, and hearing. Although, beneficiaries should consider purchasing additional coverage since this isn’t a comprehensive benefit.

Not all plans provide drug coverage; although, some Part C plans will cover drugs. It’s important 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 Medigap plan, you can’t also have a Medicare Advantage plan.

How is Advantage Part C Funded

Medicare Part C is funded by Medicare and Beneficiary premiums.

You pay your Part B premium to Medicare; then, Medicare pays a set amount of money each year to the private insurance company to handle your claims. This is why Medicare Advantage is also known as Medicare replacement coverage; Medicare will no longer handle your claims.

Therefore, if you come across a claims issue, you’ll need to work with the Medicare Advantage insurance company.

Expenses you can expect include the premium on your Medicare Advantage plan, Medicare Part B and if applicable your Medicare Part A as well as any late enrollment charges.

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