What Is Medicare Part C?

by Team eLocal
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Sorting out your health insurance options as you get older can be confusing, especially with so many moving parts to the Medicare program.

Understanding what each type of Medicare coverage is and how it works can help you get the protection you need to pay for your medical expenses.

What Is Medicare Part C?

Medicare Part C is an optional Medicare coverage plan that typically goes beyond Original Medicare coverage. It's a bundled Medicare coverage option that wraps all of your Medicare coverage into one plan, and it's offered by private insurance companies that are approved by Medicare. If you choose a Part C plan, you get your Part A and B coverage (also known as Original Medicare) through the private plan plus the extra coverage options.

What Is a Medicare Advantage Plan?

Medicare Advantage Plans are the same thing as Medicare Part C. It's just another name for the same type of Medicare health insurance from a private insurance company. Another name for the same type of plan is an MA plan.

What Does It Cover?

A Medicare Part C plan often covers medical services and procedures that Original Medicare doesn't cover. However, the specific coverage options vary by policy because they're operated by private companies. The company decides what it will cover as long as it meets Medicare requirements.

Coverage options through Medicare Advantage plans may include:

  • Your usual Part A coverage
  • Your usual Part B coverage
  • Some dental procedures
  • Some vision services
  • Hearing aids
  • Fitness programs

Every Medicare Part C plan is required to offer the same coverage as Original Medicare. Beyond that, the insurance company can decide on the additional services it wants to cover. They might limit how much of a procedure they cover. For example, the plan might cover the exam for hearing aids, but not the hearing aids themselves. It's important to understand what coverage you'll get with a Part C plan before you enroll in it.

Do You Need Medicare Part C?

Medicare Part C isn't required for anyone. It's completely optional and available to you if you qualify for Original Medicare. You can choose to only enroll in Original Medicare if you don't want the additional costs and don't need the additional coverage offered by Part C plans. Comparing the pros and cons can help you decide.

Pros of Part C Coverage

  • Covers things beyond Original Medicare
  • Optional Part D prescription drug coverage is available with most plans
  • Cap on out-of-pocket expenses
  • Wide range of plan options to fit various needs
  • Coordinated medical care between different providers

Cons of Part C Coverage

  • Often a smaller network of healthcare providers
  • Additional premiums
  • Limitations on covered services, such as not paying for private hospital rooms
  • Pre-authorization requirements
  • Restrictions on coverage area
  • Potential for higher deductibles and copays

Analyze your situation to determine if Part C is a good option. For example, if you have established relationships with your healthcare providers and they're not covered by the Medicare Advantage Plan you're considering, you might decide to stick with Original Medicare. This would allow you to continue with your current providers.

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How Much Does It Cost?

The cost of Medicare Advantage plans can vary significantly because they're offered by private insurance companies. On average, they cost about $18 per month, but pricing can range from $0 to more than $200 each month. The pricing typically depends on what each plan covers.

Even though your Part A and B coverage goes through your Part C plan, you still have to enroll in Original Medicare. With that comes a premium for your Part B coverage. The standard premium amount for 2023 is $164.90 per month. You can compare options on the Medicare site to see the plans available to you, along with pricing for each one.

How to Choose Medicare Advantage Plans

If you've decided to enroll in a Part C plan, evaluate your health situation to find a plan that works. Review the covered providers on the plans you're considering to ensure your current healthcare providers work. Look at the covered procedures on each plan and review restrictions or limitations to ensure they cover the things you need.

The premium costs for each plan also help you decide. Set a budget for the premiums to narrow down the plan options. Make sure the plans within your budget give you the coverage you want. Consider the copay and out-of-pocket maximum amounts as well to get an idea of what you'll have to pay if you need to use the insurance.

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