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.
It’s important to note that even if you meet both of these requirements, people with end-stage renal disease generally don’t qualify for Medicare Part C.
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 65. You can also apply for Medicare on the month you turn 65 and the 3 months following your 65th birthday — though your coverage will be delayed.
- If you miss the initial Medicare enrollment period, open enrollment runs from January 1 to March 31 every year.
- If you sign up during the late enrollment period, there may be additional late fees, and you won’t receive any coverage until July 1, which can leave you with a gap in coverage.
- To sign up for Medicare: You can sign up online through the Social Security’s website.
- To sign up for Medicare Part C: You can shop for Medicare Part C plans online through Medicare.gov.
The easiest way to find out what Medicare Part C plans are available is to use the Medicare tool: Find a 2020 Medicare Plan.
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.
A quick Google search for “Medicare Advantage plans in (insert your city, state, or zip code)” can also narrow down which companies in your city and state offer Medicare Advantage plans.
If you already receive coverage through another major insurance company, they may offer Medicare Part C plans. Some major insurance companies that offer Medicare Part C are:
- Kaiser Permanente
HMO, or health maintenance organization, 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.
PPOs, or preferred provider organizations, 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 co-payment 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.
Medicare Part C is different from other plans that Medicare has to offer. The other parts of Medicare coverage are known as Part A, Part B, Part D, and Medigap.
Part A (hospital insurance)
This insurance covers hospital-related services, such as emergency room trips or inpatient care. Home healthcare, nursing facility, and hospice services are also included under Part A. Medicare Part A is included in a Medicare Part C plan.
Part B (medical insurance)
This insurance covers preventive healthcare, as well as diagnostic and treatment services for health conditions. Medical transportation costs are also included in this coverage. Medicare Part B is included in a Medicare Part C plan.
Part D (prescription drugs)
This prescription drug coverage is generally best used as an add-on to Original Medicare for people uninterested in Medicare Part C. It can also be added as coverage for a Medicare Advantage plan that doesn’t cover prescription drugs.
Medigap (supplemental insurance)
Medigap and Medicare Part C are different. Medigap is supplemental coverage for what you already have with Medicare, while Medicare Part C covers all Medicare benefits. If you’re happy with your Medicare coverage but would like supplemental insurance only, Medigap is a good option.
If you’re happy with your current Medicare coverage and are only interested in receiving prescription drug coverage, Medicare Part D may suffice.
If you have Medicare coverage but only need additional help with costs, a 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.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.