What Is Medicare Part C And What Are Its Coverage Options?

Medicare Part C, also known as Medicare Advantage Plan, is one of the options you have under Medicare. This plan is available through several private insurance providers who are authorized to sell this plan by Medicare.

What is Medicare Part C?

To understand what is Medicare Part C, you need to understand that this is an option that combines the coverage offered by Part A and Part B, along with certain other areas that these two plans do not cover.

Medicare Part C plans allow you cover for your health care requirement that are not included in Part A or Part B such as dental services, hearing and vision checks, and wellness programs. Most Part C plans also provide cover for prescription drugs.

When you subscribe to Part C coverage, the amount necessary for this cover is paid by Medicare to the company from whom you have obtained the plan. However, you will have to pay some amount separately from your own pocket.

Medicare Advantage Plan Expenses

For Part C coverage, you need to pay a premium every month that is separate from the premium you pay for Part B. The amount you need to pay depends on several factors as mentioned below.

  • The number of deductibles the plan allows you ever year
  • The nature of healthcare service you require, and the frequency with which you make use of it
  • The amount of money you pay towards each service or physician visit
  • Whether a part of your Part B premium is deducted from this Medicare Advantage Plan
  • The amount specified by this plan as the allowable expense on medical services you make use of

Points to Remember

When you decide to get Medicare Advantage Plan, it is vital to keep a few of these things in mind.

First, you can choose between different plans such as the Health Maintenance Organization, the Preferred Provider Organization and the Private Fee for Service options. Make sure you understand the conditions thoroughly as specified by each option before making a decision on which one to purchase.

Second, make a note of the rules the plan specifies such as the time when you can join or opt out of the plan, the rights you have under the plan and the services covered by the plan. Pay special attention to the conditions regarding visiting a specialist doctor and receiving authorization for particular procedures or you may find out too late that you have to bear these expenses on your own.

Part C is advantageous because anyone can join this plan irrespective of their existing health condition. The only exception is that patients with end-stage renal disease are not eligible for this coverage.

Who All Are Eligible For Medicare Part B?

Medicare Part B eligibility is easy to understand – anyone who has eligibility for Part A is also eligible for Part B; all you need to do is bear the additional expense by paying a monthly premium. This amount may be drawn from your retirement benefits or the Social Security amount you receive.

If you have Part A: All persons living in the USA who receive eligibility for Medicare Part A without any premium are simultaneously eligible for Part B. However, Medicare Part B eligibility does not extend to people residing in Puerto Rico. It is important to understand a crucial point here; Medicare coverage under Part B is not compulsory. This is a voluntary program and to receive coverage under this, you have to pay a monthly premium unlike the Part A coverage that comes free of cost.

If you don’t have Part A: Even persons who do not have Part A coverage can opt for Medicare Part B provided they meet a few Medicare eligibility criteria. For one, they should be citizens of the USA. Even non-citizens are eligible, provided they have been admitted following all the specified legal requirements and have resided in the US for five years or more. Secondly, people who are aged 65 years and above are eligible for Part B. Even if you do not have Part A, you can qualify for Part B by filling out the necessary paperwork and remitting the monthly premium specified by the insurance provider.

Why choose Part B?

Part A provides Medicare coverage for hospitalization expenses. However, there can be many circumstances when you may require additional care at home, at a health care facility or a hospital on an outpatient basis. Say you have a minor accident that causes a sprain – you may not need to be hospitalized, but you may require an X-ray to rule out a fracture, a visit to the physician to obtain a prescription for painkiller medication, or physical therapy for a few days to deal with the pain and inflammation. In such cases, having Medicare Part B is crucial if you wish to keep your health care expenses low.

If you have overlooked the fact that you have Medicare Part B eligibility and not chosen this plan in the beginning, you can still enroll for it. All you need is to fill out the prescribed Medicare application and provide the necessary documentation along with the monthly premium amount. But, you need to pay a slightly higher amount as the premium, because you are enrolling late and not in the initial stage.

What Is The Difference Between Medicare Supplemental Plans And Medicare Advantage (Part C) Plans?

When you reach the age of 65 and are no longer covered by a group healthcare plan you become eligible for Medicare. Medicare was never intended to cove 100% of all healthcare costs and in general it only covers 70% to 80% of all medical expenses. The remaining 20% to 30% is your responsibility and most people choose a Medigap insurance plan. There are two types of Medigap programs, Medicare Supplemental Programs, which have been around since 1965, and Medicare Advantage Programs, also known as Medicare Part C, which have been around since 2006. Supplemental insurance plans are similar to traditional group health insurance, with out-of-pocket costs from deductibles and copays for services rendered. Medicare Advantage plans are network plans that offer coverage based on agreements about pricing with hospitals and doctors. These plans are Health Maintenance Organizations, Preferred Provider Organizations, and Private Fee For Service Plans.

The first real difference between the plans is that Medicare Advantage plans are contracted to provide Medicare Parts A and B. Medicare pays an insurance company to handle all of your healthcare needs. This means that you do not deal with Medicare at all, you will only deal with the network provider. Now all Advantage plans are required to offer at least the same amount as regular Medicare so there is no difference in the amount of coverage, the difference is in how costs and expenses are controlled.

Advantage plans offer lower monthly premiums but higher out-of-pocket costs. This means if you do not get sick or need to see a doctor you will come out ahead. The out-of-pocket costs are also capped for each year. Supplemental plans have higher premiums but little or no out-of-pocket expenses.

Advantage plans usually come with a prescription drug plan and save money by using a large group size to achieve better prices. Supplemental plans do not have prescription drug plans, so you usually get a separate plan that can be catered to your prescription needs.

Advantage plans use local networks to control costs and the benefits can change annually, but not less than what Parts A and B cover. Supplemental plans are standardized, meaning Medicare sets what each Supplement will cover and they are guaranteed to be accepted anywhere in the United State that accepts Medicare.

The last major difference is when you sign up for an Advantage plan you have to stay with that program for an entire year, and if you choose to change providers you can only do so from October 15 to December 7 for the next year. You may change a Supplemental at anytime of the year.