With its various parts and supplemental plans, the Medicare system can be difficult to navigate. This complex federal health insurance program is divided up into parts labeled with letters A, B, C and D.
Original Medicare is Part A and Part B. Medicare Part C, otherwise known as the Medicare Advantage Plan, is an alternative to Original Medicare. Part C provides coverage through health organizations outside of the Medicare system, such as an HMO or PPO. Part D offers prescription drug coverage.
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How do you know if Medicare Advantage, or "Part C," is right for you?
The ABCs of Medicare
- Medicare provides health insurance to nearly 50 million Americans
- Medicare Part A covers hospital care
- Medicare Part B covers outpatient medical procedures
- Medicare Part C Advantage Plans provide Part A and Part B through insurance companies such as HMOs, PPOs and private fee-for-service companies
- Medicare Part D covers prescription drugs though Medicare Part A and B
- Medicare typically only covers half of healthcare costs
- There are 8 supplement plans, called “Medigap” plans, which cover Medicare’s “gaps” in coverage
What Is Medicare Part C?
Medicare Part C is another name for the Medicare Advantage Plan. It is a private insurance program that allows independent health insurance companies to offer Medicare Part A and Part B in contract with the federal Medicare program.
The private plans must be Medicare-approved, and must offer Medicare Advantage benefits equal to the benefits provided by Medicare Part A coverage and Medicare Part B coverage.
This ensures that standards determined by the government are met by insurance companies offering Medicare Part C coverage.
It is typically not difficult to qualify for a Medicare Advantage program, and anyone willing to spend a few extra dollars on more comprehensive benefits can apply. You must make sure that your region offers Part C Medicare and it may be a requirement to have parts A and B first.
What Do Medicare Part C Plans Cover?
Due to government policy, Medicare Advantage health plans must include coverage for hospital stays as well as outpatient procedures. If you use Medicare Advantage, you will have the option to choose from several different plans, depending upon your state and what is available in your area.
Some of the options include PPO’s, HMO’s and fee-for-service plans. While they must provide services that are equal to Medicare Part A and Part B at a minimum, Medicare Advantage Plans can offer additional coverage as well.
For example, some may offer prescription drug benefits (which in original Medicare is called Part D), while others will not.
While you can potentially get more extensive coverage with Medicare Part C versus basic Medicare, it’s important to understand the restrictions of each plan. For example:
- One of the key things to know about Medicare Part C coverage is that you cannot combine this plan with any of the Medigap supplement plans. If you do have Medicare Advantage, you cannot receive benefits from a Medigap supplemental policy.
- You will need to understand your PPO, HMO or fee-for-service plan and work within that system. Some of these plans only cover your costs if you work with care providers within the system.
- Some Part C plans offer prescription drug coverage, and some do not. If your plan does not include prescription drug coverage, you may able to enroll in a Medicare Prescription Drug Plan (Part D). Medicare Part C and D, together, comprise a complete plan in the event that your Advantage plan does not cover prescriptions.
Working with a local independent agent who specializes in health insurance is one of the best ways to get all of the information you need to make an informed choice and get the coverage you need.
Typical Medicare Part C Costs
Because you have different options, costs vary for Medicare Advantage plans. If you already have Parts A and B, you may need to continue to pay those premiums on top of your Medicare Part C costs.
Most individuals aren’t required to pay Part A premiums because they paid social security taxes, but Plan B premiums are just over $100 per month.
Medicare Part C providers may require a deductible and many include pre-set, reasonably priced co-pays. An independent agent in our network can help you compare prices on these plans from several different providers.
How to Compare Medicare Part C Providers
Comparing different insurance policies might seem like a daunting task, but when you apply for Medicare, it’s worth the effort to examine the benefits of Medicare Part C.
Get to know the Medicare system, and compare the different types of coverage based on your eligibility.