Medicare Part C or Medicare Advantage Plan is a single alternative plan that provides benefits of both Original Medicare Part A and Medicare Part B plans. Furthermore, some Medicare Advantage Plans also cover Medicare Part D or prescription drugs coverage.
What is Medicare Part C?
Medical Part C or Medicare Advantage plan is an alternative healthcare insurance plan provided by private companies in collaboration with Medicare. Medicare Part C provides benefits of both Part A (Hospital insurance) and Part B (Medical insurance). Moreover, It covers some out-of-pocket expenses that the Original Medicare Plan does not cover such as prescription drug coverage (Part D), vision care, dental care, hearing care, fitness & wellness programs, and transportation services.
What are the Benefits of Medicare Part C?
The following are the benefits of Medicare Part C:
- Medicare Part C covers the medical and healthcare costs of both Part A and Part B. Part C is provided by private companies in a contract with Medicare.
- Medicare part C covers benefits that the original medicare part A and Part B do not cover such as prescription drug coverage, dental, hearing, and vision.
- Medicare part C might have lower copays and coinsurance as compared to the original medicare for the services such as inpatient hospital care. e
- Medicare part C may also offer wellness programs such as fitness center memberships, depending on the insurance company you choose.
How Do Medicare Part C Plans Offer Prescription Drug Coverage?
According to the Kaiser Family Foundation, in 2022, 89% of Medicare Advantage Plan (Part C) includes prescription drug coverage. This means, there are high chance that you’ll not need to enroll for Part D (which covers prescription drugs) if you have a Medicare part C plan.
There are several factors that affect Medicare Part C. They are:
The Formulary: This is the list of drugs that a plan covers. Each plan under Part C has its own formulary and cost of drugs.
The pharmacy network: This is the network of pharmacies that the insurer contracts with to provide drugs at certain prices.
The coverage rules: These are the set of restrictions or requirements that the plan may have for some drugs or conditions.
What Dental Care Options are Available with Medicare Part C?
Following dental care services are available with Medicare Part C or Medicare Advantage Plan:
- Oral exams
- Dental X-rays
- Cleaning (prophylaxis)
- Restorative services (including fillings)
- Diagnostic services
- Endodontics (Root canal)
- Periodontics (treatment of oral inflammation and gum disease)
- Extractions
- Prosthodontics (crowns, implants, bridges, and dentures)
How Does Medicare Part C Cover Vision and Hearing Care?
Hearing care – 97% of Medicare advantage plan beneficiaries had access to hearing care services in 2021. Hearing aid coverage typically involves both hearing exams and hearing aids.
Vision care – 99% of medicare advantage plan beneficiaries had access to vision care in 2021. Vision aid coverage typically involves both eye exams and eyewear (eyeglasses and/or contact lenses)
What Wellness Programs and Fitness Center Memberships are Included in Medicare Part C?
Medicare part C is in contract with various wellness programs and fitness centers. If you wish to get a gym membership or want to be a part of a wellness program through a Medicare Advantage plan then make sure you choose a plan that provides such benefits.
Your chosen plan must be covered with a fitness program such as SilverSneakers. It is a program designed for individuals 65 years and older. There are more than 17000 SilverSneakers fitness centers in the US. This program is specially tailored for the senior citizens.
What are the Drawbacks of Medicare Part C?
Medicare part C is an easy way out to grapple the medicare facilities in one go. However, it has its own disadvantages such as:
- There are only a few providers in contract with Medicare advantage plans aka closed provider networks. If you choose an out-of-network plan provider, then you might need to pay a higher fee.
- The variety of plans under Medicare advantage plan can be overwhelming. You can use Medicare’s find a plan tool, to settle on a plan that suits your medical needs.
- You’ll spend premiums, deductibles, and copays for both part A and part B, selected services of part D, and Medigap each, when you choose a medicare advantage plan.
- Original medicare offers the same coverage throughout the states of the US. However, the coverage by medicare advantage plan may differ from state-to-state.
How Do Closed Provider Networks Affect Medicare Part C Enrollees?
Closer provider networks means a group of doctors, health care providers, medical agencies, etc. who contract with the Medicare Part C plan. This enclosed group affects Medicare Part C in the following ways:
Limited choice of providers: To get the best coverage, a beneficiary may have to enroll with the network or providers in contract with Medicare part C. Outside this network, the premiums and other fees are generally high.
Lower costs and better quality: Medicare part C authorities supervise the performance and outcomes of the Medicare network providers and also negotiate lower prices with them. This helps the enrollees to benefit from lower costs and better quality.
Network fluctuations and disruptions: The plan may add or remove healthcare providers from its network. The plan can also change their contracts or locations. This may affect the availability and consistency of services to the enrollees over time.
What are the Out-of-Pocket Costs for Medicare Part C?
Out-of-the-pocket costs of Medicare Part C are:
- Deductibles
- Copayments
- Coinsurance
- Out-of-pocket maximum
How Do Monthly Premiums, Annual Deductibles, Copays, and Coinsurance Work in Medicare Part C?
The various costs for Medicare Part C are as follows:
Premiums: This is the monthly payment you make for Medicare Part C health insurance. Premium amounts are different for different health insurance providers and different plans.
Annual deductibles: These are the out-of-pocket expenses that you pay to Medicare part C before the plan starts paying for you. The deductibles too vary depending on the plan that you choose.
Copays: These are the fixed costs that you pay every time you take any service under Medicare Part C, such as doctor visits, filling prescriptions, using the emergency room, etc
Coinsurance: These are the percentage amount that you pay after meeting the deductibles.
Network fluctuations and disruptions: The plan may add or remove healthcare providers
from its network. The plan can also change their contracts or locations. This may affect the
availability and consistency of services to the enrollees over time.
What are the Out-of-Pocket Costs for Medicare Part C?
Out-of-the-pocket costs of Medicare Part C are:
- Deductibles
- Copayments
- Coinsurance
- Out-of-pocket maximum
How to Do Monthly Premiums, Annual Deductibles, Copays, and Coinsurance
Work in Medicare Part C?
The various costs for Medicare Part C are as follows:
Premiums: This is the monthly payment you make for Medicare Part C health insurance.
Premium amounts are different for different health insurance providers and different plans.
Annual deductibles: These are the out-of-pocket expenses that you pay to Medicare Part C
before the plan starts paying for you. The deductibles too vary depending on the plan that you
choose.
Copays: These are the fixed costs that you pay every time you take any service under
Medicare Part C, such as doctor visits, filling prescriptions, using the emergency room, etc
Coinsurance: These are the percentage amount that you pay after meeting the deductibles.
How Does Medicare Part C Work with HMO and PPO Health Plans?
Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) are the health networks of Medicare part C. This is how Medicare Part C works with HMO and PPO health plans:
Health Maintenance Organization (HMO): When you choose an HMO plan, you can avail services from doctors, hospitals, and other health care providers that are in the plan’s network. You get healthcare services at the lowest costs and the best coverage when you use Medicare part C’s closed network.
Preferred Provider Organization (PPO): When you choose the PPO plan, you also have the option of choosing doctors, hospitals, and other health care providers from outside the closed network of Medicare part C. However, you might have to pay high copayments when you avail of healthcare services from healthcare providers from outside the network.
What are the Differences Between Medicare Part C and Medicare Part D?
Medicare Part C collectively covers the benefits of Medicare Part A and Medicare Part B, and often part D. Whereas, Medicare Part D only covers prescription drugs.
How Do I Choose the Right Medicare Part C Plan for Me?
Consider the following factors before choosing the right Medicare part C for you:
- Make sure that your preferred doctors, hospitals, and pharmacies are in the plan’s network of Medicare part C.
- Check if your plan allows you to see the out-of-network healthcare providers. Those services usually cost more.
- Check if your Medicare advantage plan covers the prescription drugs that you take regularly.
- If gymming and exercising interests you, then you can opt for a Medicare advantage plan that covers fitness interests.
- Lastly, make sure that the Medicare Advantage plan cost fits your budget.
How Do Referrals and Prior Authorization Affect Medicare Part C Plans?
Medicare Part C is affected by Referrals and Prior authorization in the following ways:
- Referrals: Referrals are the written order from your healthcare provider that allows you to get certain medical and healthcare services under your plan. Some plans like HMOs require referrals to see specialists or take services that are covered under the plan.
- Prior authorization: To get a certain healthcare service or item, you need to get a preapproval from the plan. Some Medicare Part C plans may require prior authorization for certain services or items that are covered by the plan.
How Do I Enroll in Medicare Part C?
In order to enroll in Medicare Part C, you must have Part A and Part B plans. That means you need to pass all the eligibility criteria that part A and Part B need. You can apply for a Medicare advantage plan in the Initial Enrollment Period (IEP), Open Enrollment Period (OEP), Medicare Advantage Open Enrollment Period (MA-OEP), or Special Enrollment Period (SEP).
What is the Process for Switching Medicare Part C Plans?
You can switch to a new Medicare part C plan by enrolling in the new plan of your choice. You’ll automatically be disenrolled from the previous medicare advantage plan. However, please note that you can apply to a Medicare Advantage plan only in specific enrollment periods such as Initial Enrollment Period (IEP), Open Enrollment Period (OEP), Medicare Advantage Open Enrollment Period (MA-OEP), or Special Enrollment Period (SEP).
