Medicare Part C, What You Need to Know
Updated: Sep 18
What You Need to Know About Medicare Part C
What is Medicare Part C?
Medicare Part C, also called Medicare Advantage, is an additional insurance option for people who are eligible for Medicare. These plans are offered through private insurance companies.
With original Medicare, you’re covered for Part A (hospital services) and Part B (outpatient medical services).
Medicare Part C offers coverage for parts A and B, plus additional items and services. Some of these include prescription drugs, dental, vision, and many others.
What does Medicare Part C cover?
Medicare Part C coverage must include at least the same basic services provided by the government under original Medicare. Some of these services include:
inpatient hospital stays and treatments
limited stays at a skilled nursing facility
limited home healthcare
doctor’s visits
laboratory tests, blood tests, and X-rays
In addition to these basic coverage items, many Part C plans offer extras, including:
SilverSneakers membership or gym memberships
transportation to doctor’s appointments
home meal delivery after an inpatient stay
Are you eligible for Medicare Part C?
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.
What Medicare Part C plans are available?
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:
There are two main types of Medicare Advantage plans offered, which we’ll go over in detail next.
Medicare Advantage HMO plans
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 healthcare professionals, 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.
Medicare Advantage PPO plans
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.
How much does Medicare Part C cost?
There are a variety of costs associated with a Medicare Part C plan, which means your out-of-pocket costs may vary, depending on the plan you choose.
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 when receiving medical services.
There are many advantages of having Medicare Part C, including a yearly cap on how much you’ll pay out of pocket. Still, the initial costs can add up before you hit that cap, so it’s important to consider all your medical and financial factors when choosing a Medicare Part C plan.
Do you need Medicare Part C?
These plans are optional, but if you need more than just basic hospital and medical insurance, Medicare Part C might be a good option for you.
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 studyTrusted Source of 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.
The takeaway
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.