Medicare Part C is also referred to as a Medicare Advantage Plan. Medicare Part C plans are available through private insurance companies that are approved by Medicare. You must first have both Medicare Part A and Part B to obtain coverage under Part C. You will still be a member of the Medicare network, but a private insurance company will administer your coverage and benefits instead of getting what is referred to as ‘Original Medicare.’ Medicare Part C, or Medicare Advantage, includes plans you may be familiar with like a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) or Private Fee-For-Service administered by private insurance companies such as Cigna or Blue Cross. All Medicare Advantage plans through these private insurers must be approved by Medicare.
About Medicare Part C Coverage
Medicare Part C plans must provide the same coverage that you would receive under Original Medicare. All Medicare Part C coverage will extend to emergency care or any other types of attention that are needed in an urgent situation. Your Medicare Part C coverage may opt not to cover some services that are not deemed medically necessary under Medicare’s guidelines. You should always check with your health care provider to ensure you know which services are covered by Medicare plans.
Many Medicare Part C plans cover additional services not offered by Original Medicare such as vision and dental services. Plans from Medicare Part C may also offer coverage for your hearing as well as health and wellness plans. Most Medicare Part C coverage packages also include prescription drug coverage (Medicare Part D). However, your Medicare Part C often comes at an additional monthly premium above your payment for Medicare Part B. If you receive a medical procedure or a durable good that is not deemed medically necessary according to your Medicare Part C coverage, then you may be responsible for paying the entire amount. However, you may request a decision on whether or not your Medicare Part C plan will cover a service or good you intend to have before you pay for it. A written notification of a decision in advance will ensure that what you are requesting is covered. If the decision notifies you that Medicare Part C will not pay for it, then you will be responsible for paying for it.
Learn how you can appeal a Medicare decision to have a medical procedure or device covered by reviewing the information in our senior benefits guide.
What does Medicare Part C cost?
Medicare Part C costs can include a monthly premium, an annual deductible and copayments, which all vary depending on the plan you select. The cost for Medicare Part C is influenced by the type of plan you have, such as an HMO or PPO, and whether you stay in network or go out of network. Medical services from in-network providers will always be less than if you seek treatment from a facility not in your plan’s network. There may also be different copayments for the type of services you utilize and how often you use those. Lastly, the amount of your Medicare Part C coverage costs depend on your plan’s limits for yearly out-of-pocket expenses and whether you receive any sort of aid from your state such as being dually eligible for Medicaid.
Download our guide for more details about Medicare Part C costs and enrolling in Medicaid to reduce health care expenses.
Learn About Enrolling in Medicare Part C
Enrolling in Medicare Part C is not quite as straightforward as learning how to apply Original Medicare. Medicare Part C plans may vary in the way they work depending on where you live. Therefore, it is necessary to find the different Medicare Part C options available to you and then compare them to see which best suits your needs. You may use the Medicare website to find the different Medicare Advantage plans available in your area and then visit the websites for those plans. Once you find the plan you wish to join, you can fill out the corresponding enrollment form and return it to the administrator of that plan. All Medicare Part C coverage choices must offer you this option to enroll. You may also call Medicare’s toll-free number to sign up.
Learn About Medicare Supplemental Insurance
Supplemental insurance for Medicare, also called Medigap, helps offset costs that your Original Medicare does not take care of such as copayments, deductibles and co-insurance. Medicare supplemental insurance plans may also pay for things like coverage when traveling outside the United States. The chief distinction between Medigap and Medicare Part C plans is that a Medigap plan merely augments your Original Medicare plan while Part C is a way to obtain all of your medical insurance coverage. You must also have Medicare Part A and B to have Medigap. You may not use or be sold Medicare supplemental insurance if you are enrolled in a Medicare Advantage plan.