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What Is Medicare Part C?


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Medicare Part C is an alternative name for Medicare Advantage. Medicare Part C is another way to get your Medicare Part A and Part B benefits from a private insurance company. According to the National Institutes of Health (NIH) Medicare Part C gives Medicare beneficiaries a choice of health insurance plans. Medicare Part C also transfers the efficiencies and cost savings of managed care in the private sector to Medicare beneficiaries. Medicare Part C is still regulated by the federal government.

What does Medicare Part C cover?

Medicare Advantage plans must cover everything that Original Medicare (Part A and Part B) cover. This generally includes:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Lab tests
  • Surgery
  • Some home health care
  • Doctor visits
  • Durable medical equipment, like wheelchairs and walkers
  • Preventive services, such as certain vaccines
  • Emergency and urgent care

If you have Medicare Part C, hospice care is still covered by Medicare Part A.

Medicare Part C may also cover additional services that Original Medicare generally doesn’t cover such as:

  • Prescription drugs
  • Routine dental care
  • Routine vision care including eyeglasses
  • Routine hearing care including hearing aids
  • Fitness benefits

Coverage of supplemental benefits may vary from plan to plan. For example, some Medicare Part C plans may pay $1,000 every three years for hearing aids and some plans may not cover hearing aids.

Each Medicare Advantage plan with prescription drug coverage has its own formulary, which is a list of covered prescription drugs. Check the formulary to make sure that your particular prescription drugs are covered. The formulary may change at any time but you will receive notice from your plan when necessary.

Can I combine Medicare Advantage with other parts of Medicare?

Parts of Medicare include Medicare Part A (hospital insurance), Medicare Part B (medical insurance) and Medicare Part D (prescription drug coverage). Most Medicare Part C plans already include the benefits of Medicare Part A, Part B, and Part D so Medicare Part C should be all the coverage you need.

Another type of Medicare plan is called Medicare Supplement (Medigap). Medicare Supplement plans cover Medicare out-of-pocket costs including copayments, coinsurance, and deductibles. A Medicare Supplement plan cannot be used together with a Medicare Part C plan.

How much does a Medicare Part C plan cost?

The cost of a Medicare Part C plan can vary from plan to plan. Some costs you may pay include:

  • A monthly premium: this is the amount you pay whether you use the plan’s services or not. Some Medicare Advantage plans have a $0 monthly premium; however you must continue to pay your Part B premium.
  • A deductible: this is the amount you pay before your plan begins to pay. Some Medicare Advantage plans have separate deductibles for medical expenses and prescription drugs. Some Medicare Advantage plans do not have deductibles.
  • Copayments or coinsurance: This is the amount you pay every time you receive services. For example, you might pay a $10 copayment to visit your primary care physician and a $35 copayment to visit a specialist.

All Medicare Part C plans have an annual out-of-pocket maximum. This is a set amount, for example, $5,000, that you pay and then all of your covered medical expenses are paid for by the plan. Original Medicare has no out-of-pocket maximum.

How do I qualify for Medicare Part C?

To qualify for Medicare Part C you must:

  • Have Medicare Part A and Part B
  • Live in the Medicare Part C plan’s service area
  • Generally not have end-stage renal disease (ESRD)

To qualify for Medicare Part A and Part B you must be

  • Age 65 or older
  • Have disability and been receiving Social Security benefits for two years
  • Have Lou Gehrig’s disease (ALS)
  • Have end-stage renal disease (ESRD)

You may be able to qualify for Medicare Part C Special Needs Plan if you have ESRD.

When can I enroll in Medicare Part C?

You can enroll in Medicare Part C during your initial enrollment period. This is a 7 month period that begins three months before you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. If you miss your initial enrollment period, you can still enroll in Medicare Part C during Medicare Open Enrollment each year. Open Enrollment is from October 15-December 7.

Do you want to start shopping for Medicare Part C today? Just enter your zip code on this page to start comparing plans in your area.

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