What is Medicare Part C? What Does it Cover?

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What is Medicare?

 

Medicare is a health insurance program administered by Centers for Medicare and Medicaid Services (CMS) in the United States. This health program is designed to benefit Americans over 65 or younger for those with disability benefits from the Railroad Retirement Board or Social Security. Medicare is categorized into various plans: Part A, Part B, Part C, and Part D. People enrolled in this health program enjoy subsidized healthcare services offered by the various plans regardless of their health status and income.

 

What is Medicare Part C?

 

Medicare Part C, also known as Medicare Advantage (MA), is a Medicare health plan provided by private health insurance companies with contracts with Medicare (the federal government). Medicare Advantage is more comprehensive as it covers Part A (hospital-related insurance), Part B (medical insurance), and Part D ( prescription drugs). People enrolled in this plan enjoy more services that aren’t provided in Original Medicare which consists of Part A and Part B.

 

What is covered in Medicare Part C?

 

To fully understand what’s covered in Medicare Part C, it’s essential to know what is covered in the other plans.

Medicare Part A hospital insurance covers inpatient medical needs, home healthcare, surgery, lab tests, and hospice care.

On the other hand, Part B caters to medical services offered by doctors and nurses and essential medical equipment such as walkers and wheelchairs. In addition, the cover provides preventative care such as vaccines and screenings.

Lastly, Part D covers outpatient prescription drugs.

 

Medicare Part C will cover all the benefits featured in Part A, Part B, and Part D plans plus extra coverage not included in these plans, which includes:

  • Hearing care that includes access to hearing aids
  • An allowance to buy healthcare products
  • Wellness programs and fitness memberships
  • Visual care which includes visual exams, contacts, and glasses (except glasses after cataract surgery)
  • Transportation such as ambulance services
  • Emergency health coverage when traveling outside the United States
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Types of Medicare Advantage plans

There are six types of Medicare Advantage plans, two of which are top-rated as the most popular. They include:

 

Health Maintenance Organization (HMO)

This plan provides you with a network of healthcare providers paid by Medicare to administer healthcare services. HMOs are limited to in-network healthcare providers from whom you enjoy low rates of healthcare services.

 

Preferred Provider Organization (PPO)

This plan empowers one with the freedom to choose the healthcare providers they wish to see. These healthcare providers can either be within the network’s preferred providers or out of the network.

 

Other types of Medicare Advantage plans include:

  • Special Needs Plan (SNP)
  • Private-Fee-For-Service Plan (PFFS)
  • Medical Savings Account (MSA)
  • HMO Point-of-Service (HMO-POS)

How much does Medicare Part C cost?

 

Medicare pays some amount to health insurance companies to facilitate your coverage for the Medicare Advantage plan. Besides this amount, one may be required to pay monthly premiums for their coverage. Medicare Advantage premium for 2023 is estimated to cost roughly $18 per month. This cost is subject to change depending on factors such as the extra benefits you choose, plan type, drug coverage, deductibles, and copays. Premiums can vary from as low as $0 to as high as $250 per month, depending on one’s choice of coverage. It’s important to note Medicare Advantage plan cost is subject to change annually.

Medicare Advantage plans have different coverage rules. Before you join this plan, it’s necessary to do your research to know the services you will be required to pay for and for the hospitals, pharmacies, and doctors in the plan.

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Advantages of Medicare Advantage plan

 

Additional services

Unlike Original Medicare, Medicare Advantage features extra benefits that remain unavailable in other Medicare plans.

Cost-saving and affordable

Having three Medicare plans unified in one saves you lots of money that would otherwise be spent enrolling independent plans. Besides that, the Medicare Advantage plan has very low premiums making it affordable for many.

Offers personalized plans

Medicare Advantage has various types of plans customized to address the needs of different patients.

 

Disadvantages of the Medicare Advantage plan

 

Limited service

Some plans in Medicare Part C, such as HMO, are limited to in-network healthcare providers, which denies one the freedom to choose the healthcare facilities of their preference.

Additional costs

Medicare Advantage plans may feature additional costs from specialist visit copays and prescription drugs, among other extra charges.

 

Who is eligible for Medicare Part C?

 

  • An individual enrolled in Medicare Part A and Part B
  • People above 65 years
  • If you have Lou Gehrig’s Disease
  • If you have end-stage renal disease
  • A citizen or permanent legal citizen of the United States
  • People under 65 who receive Social Security Disability benefits