In order to be eligible for Medicare Part C, you must be enrolled in Original Medicare.
Medicare Part C is run by private insurance companies and is like other health insurance plans that are available to those under the age of 65.
Medicare Part C may require a monthly premium in addition to the Medicare premium.
Medicare Part C must legally provide the minimum benefits provided by Original Medicare and generally provide additional benefits such as dental, vision, hearing, and prescription drugs.
Medicare Part C caps your out-of-pocket expenses, unlike Original Medicare.
Medicare Part A and Part B are known as Original Medicare, but there is more to Medicare then just these two parts. Medicare Part C (Medicare Advantage Plan) is an alternative to Original Medicare. It is known for a variety of health plans that provides care from health maintenance organizations (HMOS) and preferred provider organizations (PPOS). It is run by private insurance companies in which beneficiaries pay a premium and generally covers more than Original Medicare. Regardless of the amount of healthcare each person may need, Medicare will pay each plan a fixed fee for every beneficiary who joins.
Who is Eligible to Enroll in Part C Medicare?
Although Medicare Part C provides you alternative coverage to what is provided to you by Parts A and B, you must be enrolled in Original Medicare Parts A and B to be eligible to enroll in Medicare Part C. For more enrollment and eligibility requirements visit Medicare Advantage (Part C) Enrollment and Medicare Advantage (Part C) Eligibility.
What is the Advantage of a Medicare Part C Plan?
Federal law requires Medicare Part C plans to provide, at a minimum, all the same services provided by Original Medicare Parts A and B, which include:
- Inpatient hospital stays and treatments.
- A limited number of days in a skilled nursing facility.
- Inpatient rehabilitation.
- Hospice care.
- A limited number of days of home health care.
- Outpatient doctor’s visits.
- Laboratory tests, including blood tests and X-rays.
- Limited mental health services.
- Emergency care, including ambulance transportation.
- Preventive care.
- Durable medical equipment.
Medicare Part C plans generally provide additional coverage, such as:
- Prescription drugs
- Some offer preventive health care such as gym memberships.
Who Offers Medicare Part C Plans?
Medicare Part C plans are offered by traditional health insurance companies which may include:
- Blue Cross Blue Shield
- Kaiser Permanente
- United Healthcare
You may want to ask a health insurance agent to guide you through each plan to decide which one is the best for your needs. Something to be aware of is that you must live within the geographical area required by the plan you choose.
How Much Does Medicare Part C Cost?
The cost of Medicare Part C depends on the insurance company and policy you choose. Some plans accept your monthly Medicare premium and do not charge you anything extra. Others may charge an additional premium and include a deductible. You may have a co-payment for medical services.
Medicare Part C Plans have a yearly cap on your out-of-pocket expenses. For more details visit Medicare Advantage (Part C) Costs.
Pros and Cons of Medicare Part C
People who are still covered by an employer’s health care plan generally do not benefit from Medicare Part C. Also, those with low incomes may not benefit from Medicare Part C since they may be eligible for other benefit programs without having to pay the Part C premium.
General Pros of Medicare Part C:
- Provides coverage not provided by original Medicare.
- Must cover, at a minimum, all benefits included in original Medicare.
- Generally provides a prescription drug benefit not provided by original Medicare.
- Caps out-of-pocket expenses.
General Cons of Medicare Part C:
- You may have to pay an additional premium along with the Medicare premium.
- You will likely have fewer network providers to choose from.
- Not all individual plans are the same, so you must carefully check each company’s benefits and not assume they all provide the same coverage.