Medicare Part C

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Once you have Part A and B, you can enroll in Part C. You must educate yourself on the different types of Part C plans.

Understand Medicare Advantage coverage, eligibility, limitations, and the costs that come 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 coverage by a private insurance company. Part C is an all in one Medicare Plan.

Beneficiaries can sign up for Medicare Advantage instead of Medicare 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.

For the most part, there is a network of doctors, and you must pay more if you leave the network. The Medicare Advantage plan can be beneficial for those under 65 on Medicare.

However, for many seniors, a Medicare Supplement is more suitable. Although, in 2020 more Medicare Advantage plans will be operating than before and there are more options per county; so, maybe there is a plan available for you.

The legislation signed by President Trump is giving seniors access to telehealth and more providers in more parts of the country. Also, clinicians will have more information on lower costing Part D alternatives at the time of writing prescriptions.

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

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 Part D plan.

You can also get vision and dental coverage through independent insurance. However, you can’t have both Medigap and Medicare Advantage at the same time.

Differences Between Part C Medicare and Original Medicare

Under 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 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 have coverage, or you’ll pay more for the out of network services.

By comparing Medicare Advantage vs. Medicare Supplement side by side, you can figure out which you prefer.

How Much Does Part C Cost

The average cost of Medicare Advantage is going down about 14% and it’s the lowest it’s been since 2007. There are two components to your Part C premium; Parts A and B coverage, and additional coverage from your Part C plan.

Part A coverage is free for most people, and the standard Part B premium is $144.60. You’ll pay this same Part B premium if you have a Part C plan, but you may pay an additional Part C monthly bill.

Premiums may vary widely, depending on the plan you choose and the state of residency.

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

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 essential to shop around when looking for Part C coverage.

How to Pay for Medicare Part C

To obtain a Medicare Advantage Plan you must first have Parts A and B. You’ll pay the Part B premium and additional premiums from the plan.

Some Part C plans don’t require a separate monthly premium. You can find out through your private insurer the best option for making premium payments to them.

Different plans may have different payment preferences. Often, plans offer lower prices if you pay a year upfront or if the premium payment is an automatic deduction from a bank.

Making Part C Late Payments

Sometimes life can get in the way, and you find that you’ve missed a payment and are falling behind with your Medicare Advantage plan.

Medicare has several options when it comes to late and missed payments, and it’ll ultimately be up to your policy to choose how they handle it.

Below are Medicare’s rules regarding payments:

  • Continued receipt of coverage (essentially, they do not penalize you)
  • 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 receive a warning before a plan can drop your coverage. Grace periods can range in length but must be at least two months.

This grace period is completely entirely on which plan you have. 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 there have been one or more payments that have gone unpaid during your grace period, your plan can discontinue your coverage at the end of the grace period allotment.

Rollover Grace Period – This option is considered the most flexible of options. If you owe more than one premium but manage to pay for a minimum of one premium owed during your grace period, the period will end, and your plan will notify you of a new grace period to pay your other premiums owed.

This will continue until all owed premiums are paid off. However, if you fail to make a premium payment during this time, you may be disenrolled from your plan.

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. The Initial Enrollment Period begins three months before you turn 65 and ends three months after 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 Medicare to Advantage, or switch from Advantage to Medicare.

Another enrollment period that was brought back in 2019 is called the Medicare Advantage Open Enrollment Period. This is when Advantage enrollees have a second chance during the year to make changes.

Why Do I Need Part C

Medicare Part C must offer at least the same health benefits as 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. 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

Medicare and beneficiary premiums fund Part C. 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.

Medicare Advantage is a Medicare replacement; Medicare will no longer process 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 Advantage plan, Part B, and, if applicable, your Part A as well as any late enrollment charges.

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