- Medicare Part C is one of many Medicare options.
- Part C plans cover what original Medicare covers, and many Part C plans offer additional coverage for things like dental, vision, and hearing.
- Part C is managed by private insurance companies and costs or set by those companies.
- Part C plans available to you are based on your ZIP code.
- You can search the Medicare website to see which plans ore offered in your area.
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 Medicare Part C costs, the factors that contribute to them, and compare a few plan costs from around the United States.
Medicare Advantage (Part C) 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 (Part D). 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 to doctor’s appointments.
When you choose a Medicare Part C plan, there are different plan options you can choose from. These plan options include:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
- Medicare Savings Accounts (MSAs)
Each of these plans offers different benefits depending on your medical situation.
Tips for how to choose a plan
There are many factors to consider when choosing a Medicare Advantage plan. Think about your healthcare needs, how much you can afford, the type of insurance you currently have, and how well it’s meeting your needs.
You can also use Medicare’s find a plan tool to compare plans to make sure the plan you choose covers what you need.
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 plancharges a copayment for doctor’s office and specialist visits, these costs canadd up quickly for people with chronic health conditions who make frequentoffice 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 some different costs associated with Medicare Part C plans. These costs include:
- monthly Part C 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 plan costs from major insurance providers in cities around the United States:
|Health deductible, drug deductible||Primary doctor copay||Specialist copay||Out-of-pocket max|
|Anthem MediBlue StartSmart Plus (HMO)||Los Angeles, CA||$0||$0, $0||$5||$0–$20||$3,000 in network|
|Cigna True Choice Medicare (PPO)||Denver, CO||$0||$0, $0||$0||$35||$5,900 in network, $11,300 in and out of network|
|HumanaChoice H5216-006 (PPO)||Madison, WI||$48||$0, $250||$10||$45||$6,000 in network, $9,000 in and out of network|
|Humana Gold Plus H0028-042 (HMO)||Houston, TX||$0||$0, $195||$0||$20||$3450|
|Aetna Medicare Premier Plan (PPO)||Nashville, TN||$0||$0, $0||$0||$40||$7,500 in network, $11,300 out of network|
|Kaiser Permanente Medicare Advantage Standard MD (HMO)||Baltimore, MD||$25||$0, $0||$10||$40||$6,900 in network|
The estimates above are for 2021 and are only a sampling of the many plan options offered in each area.
For a more personal estimate of Medicare Part C plan costs based on your individual healthcare situation, visit this Medicare.gov plan finder tool and enter your ZIP code to compare plans near you.
Is Medicare Advantage more expensive than original Medicare?
While it may seem like Medicare Advantage plans cost more than original Medicare, they can actually help save on medical expenses.
Most companies offering Medicare Part C plans have various ways to pay your premium. These options include:
- online bill payment
- automatic withdraw from your bank account
- automatic withdraw from your Social Security or Railroad Retirement Board benefits check
- check or money order
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 people with low-income pay for medical costs.
- Medicare Savings Program. This benefit helps Medicare beneficiaries with low-income 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.
- PACE. This is a program that can help you get coordinated care within your local community.
- Extra Help. If you meet certain income and resource limitations, you may qualify for this Medicare program, called Extra Help, to pay for prescription drug costs, premiums, deductibles, and more.
- 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 age 65 or older or have certain disabilities, you’re eligible to apply for Medicare.
- Visit the Social Security Administration website for more information on how to apply and enroll.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.