Medicare Part C, also known as Medicare Advantage, is a program of private health insurance that extends the standard benefits traditional Medicare offers. It is designed to provide additional healthcare and coverage for beneficiaries.
Consequently, it is an alternative to the standard Original Medicare plan, providing similar services but having different implications for beneficiaries, such as premiums, deductibles and copayments.
Coverage under Medicare Part C includes everything covered under Parts A and B, plus some extras. The cost of prescription medications, dental care, eye exams and other medical expenses are just a few of the numerous types of insurance available.
What Does Medicare Part C Cover?
In addition to Part A coverage for inpatient hospital care, Part B coverage for physician services and Part D coverage for prescription drug costs, Medicare Advantage Part C also covers other costs that are not included in the standard Medicare benefits. These include:
- Health screenings (e.g., flu shots, blood pressure monitoring)
- Preventive care (e.g., screenings, immunizations)
- Outpatient services (e.g., lab work, x-rays)
- Medical supplies (e.g., crutches, wheelchairs)
- Home health care (e.g., skilled nursing, physical therapy)
- Continuum of care (e.g., hospice, at-home care)
Who Is Eligible for Medicare Part C?
While the traditional Medicare program is available to everyone 65 years or older, not everyone is eligible to enroll in a Medicare Advantage plan. Medicare Advantage, like traditional Medicare, has its eligibility requirements.
To qualify for Medicare Advantage, you must meet the following criteria:
- Be a U.S. citizen or permanent resident- Alien residents who meet other eligibility requirements may be able to obtain coverage, but only under certain circumstances.
- Have attained the age of 65- If you are under 65, you may qualify for Medicare under a special circumstance, such as a permanent disability.
- Have valid Social Security Numbers- Medicare Advantage enrollment must use your Social Security number. If you have a spouse, he or she must also be enrolled in Medicare.
What Does It Cost to Enroll in Medicare Part C?
Medicare Part C plans vary in price, so your out-of-pocket expenses may change based on your chosen policy.
In certain cases, the monthly cost for Part B of Medicare will be paid for by the Medicare Part C plan you choose. However, there is a cost associated with enrolling in some of these plans and there may even be a deductible.
You can also be required to make a copayment in addition to these fees when you get medical care.
As a bonus, your out-of-pocket expenses will be capped each year with Medicare Part C. Though the out-of-pocket maximum is high, Medicare Part C premiums may add up quickly at the outset, so it’s crucial to weigh all of your options when picking a plan.
What Medicare Advantage Plans Are Available?
Health insurance providers offer many Medicare Advantage plans to provide coverage to individuals. However, there are two main types of Medicare Advantage plans offered.
1. Health Maintenance Organization (HMO) Plans
Those seeking more comprehensive health insurance than traditional Medicare providers often choose an HMO plan. Specialist treatment under a Medicare Advantage HMO plan requires a recommendation from your primary care physician.
Medicare Advantage HMO plans vary by state but often include zero-premium alternatives, no-deductible plans and minimal copayments. You must have Medicare Part A and B coverage to join a Medicare Advantage HMO.
2. Preferred Provider Organizations (PPO) Plans
Most people who need supplemental health insurance enroll in Preferred Provider Organizations (PPOs). Buyers have more flexibility with this strategy.
A PPO plan allows you to see any doctor, specialist, or hospital of your choice, regardless of whether or not they are in the insurance company’s network. On the other hand, PPO plans have separate pricing structures for in-network and out-of-network providers.
The ability to visit a specialist without a referral is another convenience for PPOs.
Other Medicare Advantage plans include Private Fee-for-Service (PFFS), Special Needs Plans (SNPs) and Medical Savings Account (MSA).
Benefits of Medicare Advantage Plans
- Lower cost: Medicare Advantage plans often have lower monthly premiums than the standard Medicare plans.
- Network: Most Advantage plans have a network of doctors and hospitals that provide services. You will have to pay more if you choose a plan that is not in your network.
- No Copayments: Advantage plans have no copayments. Copayments are the amount you pay for a doctor’s visit or prescription drug.
- No Deductibles: Advantage plans have no deductibles, so you do not have to pay a certain amount before the plan starts paying.
- No Paperwork: Advantage plans usually do not require you to fill out paperwork.
Does Medicare Part C Fit Your Needs?
Medicare Part C plans are optional, but they might be suitable if you want more comprehensive coverage than what Original Medicare provides.
A Medicare Part D plan on its own may be the best choice if you are satisfied with your existing Medicare coverage and are simply looking for medication coverage.
If you are eligible for Medicare but still want some financial assistance, a Medicare supplemental insurance policy (Medigap) may be a good option.
Many seniors find that paying for Medicare Part C is too much of a financial burden, but they may be able to save money by comparing prices on Medicare Part D and Medigap policies.
Key Takeaways
- Medicare Advantage plans, also known as Medicare Part C, are a kind of Medicare supplement insurance that may be purchased by individuals eligible for both traditional Medicare and Medicare Advantage.
- Coverage for medical expenses other than hospitalization, such as prescription medicines, eye care and dental care, is all available under Medicare Part C.
- Monthly and annual premiums, deductibles, coinsurance and out-of-pocket expenses affect how much your Medicare Part C plan will cost you.