What is Medicare Part C?
Medicare Part C is also known as Medicare Advantage.
To qualify for Medicare Part C, you must be enrolled in Medicare Part A and Part B and pay any associated premiums.
What does Medicare Part C Cover?
Medicare Part C is a comprehensive plan that includes hospitalization and doctor's visits. Fortunately, you receive one ID card to use for all your medical needs.
Some Part C plans include prescription drug coverage. Still, others let you enroll directly in a standalone Medicare Part D plan.
Medicare Part C or Medicare Advantage plans resemble health insurance you may have had through an employer. You have a network of covered providers and have copays, deductibles, and coinsurance.
Typically, Medicare Part C does not provide much if any coverage outside your home region or state. If you travel out-of-state, consider a Medicare supplement plan instead. If you travel internationally, look into travel medical insurance policies since you won't be covered outside the US.
How Much Does Medicare Part C Cost?
Usually, Medicare Part C plans can have lower premiums than Medicare supplement plans. However, you may pay more out-of-pocket like copays and deductibles.
The drawback is that Medicare Advantage plans tend to have more limited networks to reduce costs.
Some work like a PPO, Preferred Provider Organization, where you share a portion of the costs, and you can seek providers outside the network. A PPO plan can offer more options and flexibility, but more out-of-pocket expenses like copays and deductibles. It does not require you to choose a primary care physician to get a referral.
Other programs use HMO networks or health maintenance organizations. With an HMO, you choose a doctor within the HMO, and he or she gives you referrals to specialists. An HMO is more limited than a PPO because you can only see providers working within the HMO.
As a result of these organized medical networks, Medicare Advantage plans can be very affordable. Some cost as little as $0 per month.
The federal government pays a monthly amount to private insurers who provide Plan C health insurance. The insurance company is hoping that it will cost less to insure you than the government pays them. In turn, the insurer offers the lowest possible premium to attract your business. This is why some plans cost as little as $0 per month.
For Plan C, the insurance company processes and pays the claims when you go to the doctor, instead of the federal government.
How Much Will I Pay Out-of-Pocket with Medicare Part C?
You might pay a premium for your Medicare Part C plan, but that's not the only thing you pay.
Medicare Advantage (Part C) keeps your costs down better than enrolling in just original Medicare Part A and B. Part C has an out-of-pocket maximum, but original Medicare expects you to pay 20% of all costs with no ceiling.
As you review your Medicare options, each plan will tell you what the yearly out-of-pocket maximum is. If you have less than perfect health and visit the doctor frequently, consider a policy with a lower out-of-pocket limit to reduce your costs.
Alternatively, you may also look into Medicare supplement plans that tend to have lower out-of-pocket limits than Part C plans.
Once you've paid the maximum out-of-pocket amount, the plan pays 100% of the rest of your medical bills.
For many Americans, a Medicare Part C plan has valuable financial benefits.
Am I Eligible for Medicare Part C?
Like Medicare Parts A and B, Medicare Part C has a few eligibility requirements:
- Enroll in both Medicare Part A and Part B. Because Part C replaces both A and B, you must enroll in both. If you drop Part B, then Plan C cancels your coverage.
- Reside in the service area. Your Medicare Part C plan determines your eligibility based on your residential address on file with Social Security. Typically, Part C programs are particular to counties or metro areas.
- Do not have End-Stage Renal Disease (kidney failure).
- Enroll during an eligible enrollment period
What Does Medicare Part C Include?
As mentioned earlier, Medicare Part C includes everything that Parts A and B offer.
Part A pays for hospitalization, skilled nursing (not custodial/long term care), physical therapy, hospice, and home health care. Instead of paying the standard 20% coinsurance, you would pay the plan's copays and deductibles.
Part B includes medically necessary services, physician treatment, surgeries, ambulance, urgent care clinics, doctor's services, tests like MRIs and CTs, lab work, outpatient services, and preventative medicine. Again, you pay copays and deductibles instead of Medicare Part B's 20% infinite coinsurance requirement.
Many preventative services have a $0 copay, so you don't have to pay anything.
When Can I Enroll for Medicare Part C?
The Initial Election Period is a 7-month window around your 65th birthday.
Annual Election Period is when you can switch between plans. It is typically between October 15 and December 15 each year.
Special Election Period is when some other qualifying event occurs:
- Move out of the plan's service area
- Qualify for a low-income subsidy program
- Have full Medicare and Medicaid coverage
- Live in a nursing home, skilled nursing facility, or rehab hospital.
Where Can I Buy a Medicare Part C Plan?
AARDY is the nation's fastest Medicare insurance marketplace. You can compare Medicare Supplements and Medicare Advantage (Part C) plans to find the one that best fits your needs.v