Medicare is divided into many parts, which can sometimes be confusing. You may have heard of Medicare Part A and Part B already, but Medicare Part C and Part D are also essential pieces of the Medicare puzzle.
You will commonly hear Medicare Part C referred to as a Medicare Advantage plan. So, just what is Medicare Advantage, and how does it work? We will give you all the details you need to know, including how it works, how much it costs, and how to get signed up.
What Is Medicare Part C?
So, what is a Medicare Advantage plan? Medicare Part C, or a Medicare Advantage plan, is a Medicare insurance plan that rolls all your Medicare coverage into a single policy that is easier to manage and maintain.
Private Insurer
Part C is administered and managed by private insurance companies, which contract with Medicare to provide policies. The plans must include at least the same level of coverage as Original Medicare. However, the companies are allowed to set their own rules beyond that. So, as long as the minimum level of coverage is met, the insurance company can set its own coverage rules.
Medicare Advantage plans also vary in cost since the companies that manage them can set their own rules. They can set their own premium amounts, copays, deductibles, coinsurance amounts, and any other costs associated with the plans.
Added Benefits
Most Advantage plans include additional benefits beyond Original Medicare. These plans often include dental and vision benefits, along with prescription drug coverage (Part D plans). Some even offer benefits like free gym memberships to their beneficiaries.
Region Specific
You should also know that Medicare Part C is not universally available, and the plans are not standardized nationwide. This means that the plans available to you depend on where you live. The insurance companies who sell these plans can only offer them in specific states or regions. Therefore, you can only choose from the plans available in your location when you get ready for enrollment.
KEY TAKEAWAYS
- Medicare Part C is also known as Medicare Advantage. It is a health plan administered by private insurers that combines Medicare Part A, B, and sometimes D into a single plan.
- Medicare Advantage plans typically include additional benefits not covered under Medicare, such as dental, vision, hearing aids, and gym memberships.
- Like other Medicare plans, a Medicare Part C plan may require a monthly premium, deductibles, copays, and coinsurance.
Original Medicare VS Medicare Part C Plans: Coverage Differences
You want to ensure that your chosen plan has the health care coverage you need. So, what is the difference in coverage regarding Original Medicare versus Medicare Part C?
Original Medicare Review
Original Medicare consists of both Medicare Part A and Medicare Part B. So, what does Original Medicare cover?
- Medicare Part A is considered hospital insurance and covers hospital stays, inpatient care, hospice care, and care in a skilled nursing facility.
- Medicare Part B is more traditional medical insurance. It covers doctor visits, lab tests, outpatient, and preventive services.
Medicare Part C Review
Medicare Part C must provide at least the same level of coverage as Original Medicare. So, at a minimum, your Part C plan must cover the abovementioned things.
- Many Medicare Part C plans provide additional benefits beyond the minimum required coverage.
- These health plans often provide dental and vision benefits, prescription drug plans, and wellness programs.
While the details of each plan vary, such as whether it is a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), most provide extra benefits beyond what is required.
In addition to PPOs and HMOs, you will find some Advantage plans designated as Special Needs Plans (SNPs). These plans are limited to people with certain medical conditions or medical needs. You might also see Private Fee For Service plans (PFFs). These are plans in which the insurer has contracted with the medical providers to determine how much the plan will pay.
Limited Plans and Providers
Since the Federal Medicare program does not manage these plans, the types of Medicare Advantage plans available will depend on where you live. When looking at coverage details, you should also consider the size of the plan’s network. Some plan options include a limited number of healthcare providers, and most HMO plans require a referral before you can see a specialist. Ensure you fully understand the plan’s details before signing up to ensure it fits your needs best.
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Cost Of Medicare Advantage Plans
Medicare Advantage plan costs vary according to several factors, such as coverage details, copay amounts, and deductibles. Like traditional health insurance plans, the insurer can set its rates.
Monthly Premium Cost
Some Medicare Advantage plans have no monthly premium, so these plans have no premium cost. On the other hand, some of the best Medicare Advantage plans have premiums ranging from $50 to $200 per month.
Some plans even offer a Medicare Give Back benefit. This means that your Advantage plan provider will help cover a portion of your Medicare Part B premium.
Deductibles & Copay Costs
In addition to the monthly premiums, other out-of-pocket costs are associated with Medicare Advantage plans. With most plans, you will be responsible for meeting an annual deductible and paying copays or coinsurance amounts when you receive medical services.
Medicare utilizes a fee-for-service model, which means that physicians are paid according to the number of procedures they perform, not necessarily related to the quality. Many people choose to use a medical savings account (MSA) to help cover some of these out-of-pocket expenses.
TIP
Before selecting a Medicare Advantage plan, it is essential to evaluate the total cost of coverage. There are many zero-premium Advantage plans; however, they may have much higher deductibles or copays than Original Medicare.
How To Enroll In A Part C Medicare Plan
Enrollment in a Medicare Part C plan is not difficult. First, you must be eligible for Medicare to sign up for a plan. Then, you will need to find the plans available in your local service area. You can visit the Medicare plan finder tool to find plans that are available to you.
You might also ask your insurance agent for assistance finding and selecting a plan. Once you find the right plan, you must contact the insurance company that manages the plan to get signed up. However, you cannot sign up at any time.
Initial Enrollment Period
Signing up during your initial enrollment period is generally best to avoid any late enrollment penalties. This period begins three months before your 65th birthday, runs through your birthday month, and ends three months after your birthday.
Special Enrollment Period
You may be eligible for a special enrollment period if you miss the initial enrollment period. This often applies to individuals still employed and receiving health care insurance through a group plan with their employer. Upon retirement, you can sign up for coverage without the late penalty.
Open Enrollment Period
Finally, Medicare has a Medicare Advantage open enrollment period each year, during which you can get signed up for a plan. The insurance company you select will provide you with an insurance card and all the details about your new plan.
Medicare Part C & Medigap — How They Work Together
Now that you understand Medicare Part C, let’s discuss Medicare supplement plans — or Medigap. While they might sound similar, there are some significant differences when comparing Medicare Advantage vs. Medigap.
Medigap helps pay for out-of-pocket expenses not covered by Original Medicare. These can include items like copays, deductibles, and coinsurance amounts. Once your Medicare Part A benefits are used up, Medigap sometimes includes additional services not covered by Medicare, like extended hospital stays.
These Medigap plans are administered by private insurance companies and require a monthly premium. There are about ten different plans to choose from, and the plans are mostly standardized across all states.
- The biggest thing to note is that Medigap plans do not work together with Medicare Part C plans. The two types of plans are mutually exclusive, meaning that you can only be enrolled in one or the other, not both.
If you opt for a Medigap plan, you must enroll in Original Medicare. Similarly, if you decide to enroll in a Medicare Advantage plan, you will not be eligible for Medicare supplement insurance.
The Bottom Line
Medicare Part C allows Medicare beneficiaries to lump all their Medicare coverage into a single plan. This often makes it much easier to manage your healthcare expenses.
Many of these plans include extra benefits beyond what Original Medicare covers. They might cover dental services, vision services, hearing aids, urgent care visits, etc.
The details of each plan vary since the private insurance companies that manage the plans are allowed to set their own rates and rules. However, these plans must provide at least the same level of benefit as Original Medicare.
Frequently Asked Questions
No, Medicare Part C is not required. If you choose not to enroll in Part C coverage, there is no penalty for not enrolling.
These are optional plans that can replace your Original Medicare coverage. Some find these plans better meet their needs than Original Medicare coverage.
However, Medicare Advantage plans are not the best option for everyone. It would help to examine all your options closely before ultimately selecting the plan you will use.
Medicare Part D is prescription drug coverage. It provides benefits that help pay for prescription drugs and medications. Part D coverage is optional but can be added to your Original Medicare coverage.
Part C plans combine all your Medicare coverage into a single plan and policy. Part C is also called Medicare Advantage. These plans often include Part D coverage as part of their benefits.
One of the most significant benefits of Part C coverage is that it allows you to easily manage and maintain all your Medicare coverage through a single plan. In some cases, Part C leads to lower overall healthcare expenses. This will depend on your situation.
Another significant benefit of Part C plans is that they often provide additional benefits beyond regular Medicare benefits. This includes dental and vision coverage and other benefits like gym memberships. Many plan participants find these extra benefits extremely useful.
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