Medicare Advantage Plan
Medicare

Everything You Need to Know About Medicare Part C Coverage

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Medicare Advantage is a sort of All-in One option to standard Medicare. Medicare Advantage, also known as Part C, basically brings together various Medicare Plans but most often include Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (drug coverage) as well as the option to choose additional coverages to suit your unique needs.

Keep reading. We’re going to tell you everything you need to know about Medicare Part C coverage so you can make the best choice for you.

Our goal at ConsumerCoverage is to help you understand your options and help you get quotes and compare those options. Get informed, review your options, and choose a plan. We’ve Got You Covered!

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Table of Contents

Original Medicare vs. Medicare Advantage

The first point of consideration is that Medicare represents two different health plans: Original Medicare and Medicare Advantage. So before you make any decisions, you should know the difference between your coverage options.

Original Medicare: Includes Part A (hospital care) and Part B (outpatient care such as doctor’s appointments). In addition, you’re eligible for Medigap or Supplemental coverage (including Part D prescription drug coverage) to drive your out-of-pocket expenses down. 

Some other attributes of Original Medicare include:

  • You’re not limited to in-network providers, which means you can pick any physician that accepts Medicare.
  • Part A costs are usually covered.
  • Part B is based on your income.
  • You’re responsible for paying coinsurance, premiums, and deductibles if you don’t have Medigap. If you have Medigap, it’ll help pay for these costs.

Medicare Advantage: Medicare Advantage or Medicare Part C bundles Part A, Part B, and a combination of other features (depending on which plan you select) like prescription, dental, vision, hearing, and fitness memberships. This means you aren’t eligible for Medigap Supplemental plans as it’s built into your coverage. 

Some other Medicare Advantage Plan features include:

  • You must use in-network providers.
  • There are low-cost premiums, coinsurance, copays, and deductibles.
  • You have a yearly out-of-pocket expense limit.
  • Medicare Advantage is purchased through private insurance companies, but the federal government regulates it.

Understanding Medicare Part C

The most common Plan C coverage options are:

Medicare Advantage Plan Choices
Features Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Special Needs Plans (SNPs)
Overview Low cost. Greater selection to doctors that aren’t in your network. You’re eligible for SNP if you have a qualifying health condition like diabetes, you have Medicare and Medicaid or live in an in-network assisted living community/home.
Primary doctor oversees your care and refers you to specialists. See specialists without a doctor’s referral.
Limited to in-network doctors.
Out-of-Pocket Expenses Care is provided by in-network doctors, hospitals and clinicians, unless it’s an emergency. Offers preferred in-network care and gives enrollees discounts for using them. You will have a primary doctor to oversee your care. Most SNPs rely on in-network care.
Seeing non-essential out-of-network doctors costs more. Higher overall costs. Some SNPs have $0 copays, premiums and deductibles. They also offer additional funds for over-the-counter health items.
Doctors Care is provided by in-network doctors, hospitals and clinicians, unless it’s an emergency. Offers preferred in-network care and gives enrollees discounts for using them. You will have a primary doctor to oversee your care. Most SNPs rely on in-network care.
A referral is required to see a specialist. Out-of-network care is permitted at a higher copay. SNPs are for individuals living with certain health conditions or are deemed low income.
No referral to see a specialist is necessary. Referrals are required to see specialists.

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Who Is Eligible For Medicare Part C Plans?

Like standard Medicare, not everyone is eligible for Medicare Part C. It’s a plan designed for older individuals and disabled individuals.

Here are the criteria for Medicare Advantage plan eligibility:

  • Senior citizens who are 65 years old or older
  • Disabled adults who have taken the disability benefits from Railroad Retirement Board (RBB) or Social Security
  • Individuals who have been diagnosed with ESRD (end-stage renal disease) or amyotrophic lateral sclerosis (ALS, “Lou Gehrig’s disease”)

To apply for Medicare Part C, you must also already be enrolled in Medicare Part A and B and be living in the service area of the Medicare Part C provider you are applying to be covered by. 

Coverage Under Medicare Part C Plans

As mentioned, your coverage under Medicare Part C is more extensive than the coverage in traditional Medicare. 

In addition to the usual coverages under Medicare Part A, B, and D (so medical, hospital and drugs), Medicare Part C can also cover the following:

Vision
Hearing
Dental
Fitness programs
Transportation
Over-the-counter drugs
Services that support your health and wellness

And remember, Medicare Part C allows you to tailor your package, so you can get the most well-rounded health insurance for you. 

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Three Basic Costs Involved for You to Have and Use Medicare Part C

  1. Premiums: Premium is the amount you pay on a monthly basis simply to have Medicare Advantage available to you, regardless of whether you use it or not. Unlike basic Medicare, Med Advantage is issued by private insurance companies and the premiums will vary from company to company. In some cases, no premium is charged to the consumer.
  2. Deductibles: Deductibles are basically a dollar threshold amount that you must pay before your coverage kicks in. If the medical service you seek costs less than your deductible, your insurance won’t kick in until the amount exceeds your deductible.
  3. Co-insurance: Co-insurance is basically your share of approved Medicare costs after you pay your deductible. As an example: for Medicare Part B outpatient coverage, you pay 20% of the Medicare-approved costs, after you pay your deductible. A Medicare Advantage plan can help offset those coinsurance costs.

So Is Medicare Part C Affordable?

Yes. In fact, it’s generally more affordable than standard Medicare. When you enroll in Medicare Part C, you keep paying your Medicare Part B premium and depending on the coverage you opt for, there may be an additional premium. 

The best way to get a handle on whether this plan is right for you is to get a Medicare Part C quote. Contact us. We’ve partnered with the top providers of Medicare Part C coverage and will get you the best coverage at the best price. 

How to Enroll in Medicare Part C?

The Medicare Advantage Enrollment period runs every year from January 1st to March 31st. 

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How to Compare Medicare Advantage Plans

To help narrow down the best plan for your needs, you’ll want to ask yourself these questions:

  • Do you want to select your care provider?
  • How much can you afford to pay for your monthly premiums?
  • Do you have a plan preference (HMO, PPO, or SNPs)?
  • How much can you afford to pay out-of-pocket?
  • Do you have a small or large selection of in-network care providers?
  • What additional benefits do you need?

Once you start to answer these questions, it becomes easier to figure out which plan best suits your needs. For instance, if you absolutely want to be able to pick your own doctor, you’ll need a PPO plan unless you can afford to pay extra for out-of-network care.

What Are the Disadvantages of Medicare Part C?

The main drawbacks of Medicare Part C center around its limitations in terms of providers. To get the lowest cost, you need to use providers in the plan’s network and service area. This may be too limiting to some people. 

Coverage can also vary from plan to plan, meaning you could be paying more out-of-pocket costs if you don’t get the best provider for you. 

Your Medicare Part C provider may also have company-specific rules about whether or not you need a referral to see a specialist.

However, all Medicare Part C pays a fixed amount for your care every month to the insurance provider you have selected, and these companies must adhere to the rules established by Medicare so you can rest assured you are getting solid coverage.

The Takeaway: Is Medicare Part C Right for Me?

If you meet the Medicare eligibility requirements and are looking for single-policy, comprehensive coverage, then Medicare Part C is definitely worth considering. It offers you a full-spread of health insurance coverage, at an affordable rate.

Frequently Asked Questions:
As long as you make plan changes during Medicare open enrollment, you can do so as many times as you like. If you attempt to change plans outside of open enrollment without a qualifying event, you likely won't be able to make the change.
There are two primary points that you can purchase a MediGap Policy: (make bullet points) Bullet point #1: Each year there is an Annual Enrollment Period (AEP) for Medicare Supplement and it opens October 15th and runs through December 7th. Note that changes you make to your policy during OE (Open Enrollment) will take effect January 1st. (Bullet point #2:) Initial Eligibility takes place the month of your 65th birthday and you can buy any MediGap policy available in your state. This period starts automatically the month you're 65 & enrolled in Medicare Part B.
When first eligible for Medicare, you have a 7 month enrollment period to sign up for Part A and/or B. Note this period starts 3 months before the month you turn 65, during the month of your birthday and ends 3 months after the month you turn 65. From January 1st - March 31st you can sign up for Medicare Part A and/or B if a) you didn't sign up when you were first eligible and b) you aren't eligible for a Special Enrollment period
Medicare & all of its parts can be quite complicated. There are 3 simple qualifiers to determine if you qualify for a Medicare Advantage Plan, which are offered by private insurance companies, not the government, and those qualifiers are: 1) You live in a service area for the plan you are interested in; 2) You Must be currently enrolled in Medicare Part A & B; and 3) You Don't have End-Stage Renal Disease (ESRD)
Open Enrollment for Medicare Advantage runs annually from January 1st - March 31st. During this time, if you are currently enrolled in an Advantage plan you can switch a different Advantage plan or even revert back to original Medicare. Be sure you understand your options, be informed and Get Covered.
Medical care, hospital care, prescription drugs, vision, dental, fitness services, and other health related services. Speak to your provider to see what options are available for you.
Some Medicare Part C policies have $0 premiums, but may have co-pays. The average monthly premium, however, is around $33.
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