Medicare Part C: What to know

Medicare Part C is a bundled Medicare plan that for most people includes coverage of hospital, medical, and prescription drugs. It also includes additional services which are not covered by traditional Medicare plans, such as dental, hearing, and vision care. Coverage for these, though, varies among plans.

Medicare Advantage is another name for those plans. While they often provide more coverage than a traditional Medicare plan, Medicare Advantage people have to choose from a network of doctors and health care providers on whom Medicare and the plan providers have agreed. It will be more expensive to receive care outside of those networks.

Private health-insurance companies approved by Medicare administer Medicare Advantage. They must follow the rules established by Medicare, since Medicare sends over a fixed amount of money each month to fund an individual’s Advantage Policy.

We explain the details of Medicare Advantage in this article, as well as how it differs from traditional Medicare policies.

What is Medicare Part C?

Usually, a person can get hospital and medical attention as part of their cover for Medicare Part C.
Usually, a person can get hospital and medical attention as part of their cover for Medicare Part C.

Medicare Advantage plans are offered by thousands of health insurance companies. Its availability varies according to region.

Types

According to Medicare.gov, the plans usually fall into one of five categories.

  • Health maintenance organization (HMO): To receive discounted treatment in an HMO plan, a person must receive care from a fixed network of healthcare providers. These doctors, clinics, and hospitals have agreed to provide discounted services to people who hold this plan. Often, a person must also receive a referral from a primary care doctor for specialty medical care under an HMO plan. If an individual receives care from an out-of-network provider, they may have to pay full price.
  • Preferred provider organization (PPO): PPO plans are similar to HMOs. A person saves money by choosing in-network providers. However, a PPO organization may also fund a portion of care for an out-of-network provider. Treatment under these plans does not usually require a primary care provider’s referral.
  • Private fee-for-service (PFFS): People with PFFS plans have agreements with providers who accept Medicare. This agreement requires doctors to charge a specified amount for their medical services. Not all Medicare-approved providers accept these plans. Some PFFS plans may specify in-network doctors, while others do not.
  • Special needs plans (SNPs): SNPs are plans that help those with specific chronic medical conditions. These people may use prescription medications and doctor services more regularly. Examples of medical conditions with SNPs include chronic heart failure, dementia, diabetes, end stage liver and kidney diseases, and HIV. All SNPs offer prescription drug coverage.
  • Medical savings account (MSA): These plans combine a highly deductible insurance plan and a savings account for medical care. An individual with that plan has a high deductible. They can use their MSA money to help fund the costs of health care before they need to meet their deductibles. This means a person will be able to fund medical expenses before insurance pays. Many MSA plans allow a person to seek care from whatever provider they select.

Not all schemes are available in every region. Areas with larger populations generally have a greater variety of plans available.

Average costs

It can be difficult to provide average costs for Medicare Part C, as there is a wide range of plans available. Different personal circumstances, such as income and a history of paying Medicare taxes, also inform the cost of a policy.

A Medicare Advantage plan has its own premium, which can sometimes be zero dollars. According to some estimates, the average monthly Medicare Advantage premium is $29. Some plans have monthly bonuses exceeding $200, however.

Each plan requires individuals to meet a specified amount of out- of-pocket costs before their plan starts paying for healthcare services. This can sometimes amount to thousands of dollars.

A person with a specific Medicare Advantage plan in Philadelphia County, Pennsylvania, has paid an average annual out- of-pocket sum of $3,950 according to a public policy issue brief from the University of Pennsylvania Wharton School.

That is less than the $6,180 paid out- of-pocket costs by people with traditional Medicare across the same region.

The out- of-pocket figure is the amount of money which a person can expect to spend for medical costs in addition to their premium.

Some people may enjoy significant cost savings, depending on where they live, when using Medicare Advantage.

Eligibility for Medicare Part C

Eligibility for Medicare Part C plans depends upon the following criteria:

  • Geographic area: Medicare advantage plans are typically unavailable or less available in geographic regions with a lower population, such as Alaska and Wyoming. People in larger cities often have the most plans available to them.
  • Medical conditions: To qualify for a special needs plan, a person must have the medical condition the plan covers.

The Medicare website allows a person to look in their area for available Medicare Advantage plans. A person can enter his or her zip code and view a list of available plans.

Medicare Part C vs. other plans

The Medicare Part C plans are different from the traditional Medicare policies. Part C bundles services together may offer more services than traditional Medicare, including dental, vision, and hearing care, depending on the plan.

In addition to traditional Medicare, people should check their individual plans to see what it covers. Businesses offer a lot of different plans.

  • If a person uses traditional Medicare, they pay Medicare directly, and Medicare pays out for their services.
  • Medicare Part B: A person pays their Medicare Part B premium directly to the government.
  • Medicare Part C: People with Part C pay a private insurance company.
  • Medicare Part D: Medicare Part D is the traditional portion of Medicare that pays for prescription drug coverage. A person can select from several plans and pay a monthly premium directly to the government.
  • Medigap: Medigap insurance can help a person pay for co-payments and deductibles, as well as other out-of-pocket expenses.

Some people prefer the freedom to select their own providers and specialists who can come along with traditional Medicare.

Summary

An alternative to traditional Medicare is Medicare Part C, or Medicare Advantage. When a person opts for Medicare Advantage, they can select a plan that does not cover Medicare’s additional services.

Plan availability varies by geographic area, and when selecting the best Medicare Advantage plan for them a person must consider availability, coverage and cost.

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