Original Medicare and Medicare Part C are different insurance options with different costs.
Several factors determine Medicare Part C costs, such as premiums, deductibles, copayments, and coinsurance. These amounts can range from $0 to hundreds of dollars for monthly premiums and yearly deductibles.
In this article, we’ll explore the factors that contribute to Medicare Part C costs and compare some plan costs from around the United States.
Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare provided by private insurance companies.
If you already receive Original Medicare but want additional coverage for prescription drugs and other services, Medicare Part C might be a good option for you.
With most Medicare Part C plans, you’re covered for:
- Hospital coverage (Part A). This covers hospital services, home healthcare, nursing facility care, and hospice care.
- Medical coverage (Part B). This covers preventive, diagnostic, and treatment-related healthcare visits.
- Prescription drug coverage. This covers monthly prescription drug costs.
- Dental, vision, and hearing coverage. This covers yearly checkups and some necessary assistive equipment.
- Additional perks. Some plans cover healthcare perks, such as gym memberships and transportation.
When you choose a Medicare Part C plan, there are different plan options you can choose from. These options include:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs plans (SNP)
- Medicare Medical Savings Account (MSA) plans
Each of these plans offers different benefits depending on your medical situation.
To be eligible for a Medicare Part C plan, you must be enrolled in Medicare parts A and B. Here are the costs for Medicare parts A and B.
Medicare Part A costs
Premium: Can range anywhere from $240 to $437. Most people who are receiving retirement benefits don’t have to pay a Part A premium.
Deductible: $1,364 for each benefits period.
Coinsurance: Can range anywhere from $341 to $682-plus, depending on the length of time during each benefits period.
Medicare Part B costs
Premium: $135.50 per month, but may be higher depending on your income. Some Medicare Part C plans will cover your Part B premium.
Deductible: $185 for each benefits period.
Coinsurance: 20 percent of all services after the deductible amount has been met.
For people who receive Social Security or Railroad Retirement Board benefits, your Part B premium amount is automatically deducted when you receive your benefits payments. If you don’t receive either of these benefits, then you’ll be billed directly for your part A and B premiums.
There are some different costs associated with Medicare Part C plans. These costs include:
- a monthly plan premium
- Part B premium
- in-network deductible
- drug deductible
Your costs may look different depending on your coverage, plan type, and whether you receive any additional financial assistance.
Below is a small sample of Medicare Part C costs in major cities around the United States:
|Part B premium||In-network deductible||Drug deductible||Copays & co-insurance||Out-of-pocket max|
|Anthem MediBlue Plus (HMO)||Los Angeles, CA||$0||$144.60||$0||$0||$20–$50||$6,700|
|WellCare Value (HMO)||Seattle, WA||$0||$144.60||$0||$0||$0–$25||$5,900|
|Humana Gold Plus H0028-025 (HMO)||Denver, CO||$0||$144.60||$0||$95||$0–$40||$4,500|
|Assurance Rx (HMO-POS)||Madison, WI||$0||$144.60||$0||$330.00||$20–$50||$6500|
|Humana Gold Plus H0028-043 (HMO)||Dallas,TX||$0||$144.60||$0||$200||$0–$20||$5,200|
|Bright Advantage Flex Choice (PPO)||Nashville, TN||$0||$144.60||$0||$0||$0–$35||$5,900–$10,000|
|Humana Gold Plus H3533-006 (HMO)||Albany, NY||$0||$144.60||$0||$300||$0–$35||$6,700|
The estimates above are for 2020 and don’t include prescription drugs costs, which may differ depending on your medications.
For a more accurate estimate of Medicare Part C plan costs based on your individual healthcare situation, head to Medicare.gov and enter your zip code to compare plans near you.
While it may seem like Medicare Advantage plans are more expensive than Original Medicare, they can help save on medical costs.
Most of your Medicare Part C costs will be determined by the plan you choose. However, your lifestyle and financial situation can also have an impact on your costs.
Here are some of the most common factors that affect what you’ll pay for a Medicare Part C plan.
Some Medicare Part C plans are “free,” meaning they don’t have a monthly premium. Even with a zero premium Medicare Advantage plan, you may still owe a Part B premium.
Most Medicare Part C plans have both a plan deductible and a drug deductible. Many (but not all) of the free Medicare Advantage plans offer a $0 plan deductible.
Copayments and coinsurance
Copayments are amounts you’ll owe for every doctor’s visit or prescription drug refill. Coinsurance amounts are any percentage of services you must pay out of pocket after your deductible has been met.
If your plan charges a copayment for doctor’s office and specialist visits, these costs can add up quickly for people with chronic health conditions who make frequent office visits.
The type of plan you choose can also have an impact on how much your Medicare Part C plan may cost. For example, if you’re on an HMO or PPO plan but choose to visit an out-of-network provider, this can increase your costs.
While Original Medicare covers services nationwide, most Medicare Advantage plans are location-based. This means that if you travel often, you may find yourself stuck with out-of-town medical bills.
Your yearly gross income can also factor into how much you’ll pay for your Medicare Part C costs. For people with a lack of income or resources, there are programs that can help lower your Medicare costs.
One advantage of Medicare Part C is that all Medicare Advantage plans have an out-of-pocket maximum. This amount varies but can range from the low thousands to upward of $10,000-plus.
managing part c costs
One of the first things you can do to manage your Medicare Part C costs is to read through the following annual notices from your plan:
- Evidence of Coverage (EOC)
- Annual Notice of Change (ANOC)
These notices can help you determine exactly what costs you’ll pay out of pocket for your plan, as well as any price changes that will take effect the following year.
There are four qualifications that make you automatically eligible for Medicare.
All Americans are automatically eligible to apply for Medicare 3 months before their 65th birthday.
People under 65 qualify for Medicare if they currently receive Social Security disability payments.
You’re automatically enrolled in Medicare if you receive Social Security disability benefits for 24 months. If you’re not automatically enrolled into Medicare but meet the criteria above, head over to the Social Security’s website today to apply.
People with ALS who receive disability benefits automatically qualify for Medicare.
End stage renal disease
help paying for medicare
If you’re having trouble paying your Medicare Part C costs, there are resources that can help:
- Medicaid. This program helps low-income people pay for medical costs.
- Medicare Savings Program. This benefit helps low-income Medicare beneficiaries pay plan costs, such as premiums and copayments.
- Supplemental Social Security. Some individuals can apply for Supplemental Social Security benefits, which are monthly payments that can help pay for Medicare costs.
Medicare Part C is a great coverage option for Medicare beneficiaries who are looking for additional coverage.
Your Medicare Part C costs will include premiums, deductibles, copayments, and coinsurance. Your costs will also be determined based on your plan type, how often you need medical services, and what type of doctors you see.
If you’re 65 or older or have certain disabilities, you’re eligible to apply for Medicare. Head on over to Social Security’s website for more information on how to apply for coverage.