Medicare Part C, also called Medicare Advantage, is an additional insurance option for people with Original Medicare.
Medicare Part C offers coverage for parts A and B plus additional services, such as prescription drugs, dental, vision, and more.
In this article, we’ll explore what Medicare Part C has to offer, how much it costs, and how to choose the best plan for your situation.
Medicare Part C coverage is additional Medicare coverage offered through private insurance companies. With this plan, you can get coverage for prescription drugs, dental and vision services, and other health-related services.
What Medicare part c covers
With the right Medicare Part C benefits, you will have coverage for the following:
- hospital services, nursing facility care, home health care, and hospice care
- medical services related to the prevention, diagnosis, and treatment of conditions
- mental health services
- prescription drug coverage
- dental, vision, and hearing services
- optional health services, such as fitness memberships
If you need more than just basic hospital and medical insurance, Medicare Part C is an essential coverage option.
You qualify for Medicare Part C if you already have Medicare parts A and B, and if you live in the service area of the Medicare Part C provider you are considering.
In 2021, people with end stage renal disease (ESRD) are eligible to enroll in a broader range of Medicare Advantage plans due to a law passed by Congress. Before this law, most plans would not accept you or limit you to a Special Needs Plan (SNP) if you had a diagnosis of ESRD.
what you need to know about enrolling in medicare
- Enrollment into Medicare is time-sensitive and should be started roughly 3 months before you turn age 65. You can also apply for Medicare on the month you turn 65 and the 3 months following your 65th birthday — although your coverage will be delayed.
- If you miss the initial enrollment period, open enrollment runs from October 15 through December 7 every year.
- You can sign up for original Medicare online through the Social Security Administration website.
- You can compare and shop for Medicare Part C plans online through Medicare’s plan finder tool.
The easiest way to find out what Medicare Part C plans are available is to use the Medicare tool:.
The system will take your answers to certain questions and narrow down the companies that offer Medicare Part C plans that fit your needs. This Medicare tool is helpful for comparing the plans in your area.
If you already receive coverage through a major insurance company, it may offer Medicare Part C plans. Some of the major insurance companies that offer Medicare Part C are:
Health Maintenance Organization (HMO) plans are a popular option for those who want additional coverage not offered by original Medicare. In a Medicare Advantage HMO plan, you can receive care from your plan’s in-network health care providers, but you will need to get a referral to see a specialist.
There are many options for Medicare Advantage HMO plans in each state, including plans with $0 premiums, no deductibles, and low copayments. To enroll in a Medicare Advantage HMO plan, you must already be enrolled in original Medicare.
Preferred Provider Organizations (PPOs) are the most popular healthcare plan choice for additional coverage. This type of plan allows a greater level of freedom for buyers.
With a PPO plan, you can go to your preferred doctors, specialists, and healthcare facilities, whether or not they are in your plan’s network. However, PPO plans do charge different rates based on a list of in-network or out-of-network providers.
PPOs are also convenient because you don’t need a referral to see a specialist.
There are a variety of costs associated with a Medicare Part C plan, which means your out-of-pocket costs may vary.
Some Medicare Part C plans will cover a portion of your Part B monthly premium. However, some of these plans also have their own premium and deductible.
In addition to these costs, you may also owe a copayment at the time of receiving services.
other factors that affect cost
Other factors that contribute to how much a Medicare Part C plan will cost you include:
- the type of plan you choose, such as an HMO, PPO, PFFS, SNP, or MSA
- your income, which can be used to determine your premium or deductible amount
- your percentage of costs
- how often you need medical services
- whether you receive medical services in network or out of network
- whether you receive other financial assistance, such as Medicaid
There are many advantages of having Medicare Part C, including a yearly cap on how much you’ll pay out of pocket. Still, those initial costs can add up over time before you hit that cap, so it’s important to consider all the factors when choosing your Medicare Part C plan.
If you’re happy with your current Medicare coverage and are only interested in receiving prescription drug coverage, a stand-alone Medicare Part D plan may be the best option.
If you have Medicare coverage but only need additional help with costs, a Medicare supplemental insurance (Medigap) policy might work for you.
For some people, Medicare Part C is an additional cost that they just can’t afford — in this case, shopping around for Part D and Medigap coverage may help save money.
helping someone enroll?
Helping a family member or friend choose a Medicare Part C plan can be an in-depth process, but it doesn’t have to be difficult. Here are some things to consider when reviewing plans:
- Type of coverage. If your family member is interested in coverage options that parts A and B don’t offer, try to find a plan that covers all the areas that are important to them.
- Type of plan. Choosing the right type of Medicare Part C plan largely depends on their personal preference. HMO, PPO, PFFS, SNP and MSA plan structures should all be considered.
- Out-of-pocket costs. Low income can make it difficult to meet Medicare Part C premium, deductible, and out-of-pocket costs. Try to shop around for rates they can afford.
- Medical situation. Every person has a unique health situation that should be considered when shopping for Medicare coverage. Consider things like health conditions, frequent travel, and provider preferences.
- Other factors. A
studyof over 800,000 beneficiaries found that factors such as the market share of the organization and star rating were also considered when choosing a Medicare Part C plan.
- Medicare Part C plans, also known as Medicare Advantage plans, are optional insurance plans that offer the benefits of both original and additional Medicare coverage.
- Medicare Part C is a great option for people interested in coverage for prescription drugs, vision and dental services, and more.
- The cost of a Part C plan depends on a variety of factors, including monthly and yearly costs, copayments, and your medical needs.
- Visit Medicare.gov to find a Medicare Part C plan that works for you.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.