Medicare Advantage, commonly referred to as Medicare Part C, combines Medicare Part A and Part B coverage into one plan offered by private health insurance companies. Part C offers additional benefits such as dental, vision, prescription drug, and hearing coverage. Individuals who enroll in Part C will receive their health benefits through a Medicare Advantage plan. Some Medicare Advantage (Part C) plans even include fitness benefits. Here we will explore Medicare Part C and the additional benefits it provides.
Medicare Part C vs. Original Medicare
The primary difference between Original Medicare and Medicare Advantage is how coverage is administered and structured. Original Medicare only consists of Part A (hospital coverage) and Part B (medical coverage). This coverage is administered directly by the federal government. Medicare Part C, on the other hand, is administered by private insurance companies approved by the federal government. Medicare Part C includes more benefits than Original Medicare and often requires enrollees to utilize an in-network system of providers to obtain full benefits. The choice between the two types of Medicare should depend on personal healthcare needs and preferences.
What Does Medicare Part C Cover?
Medicare Part C offers coverage for hospital stays, inpatient care, hospice care, home health care, skilled nursing facility care, and care in religious non-medical healthcare institutions. This coverage incorporates services such as room and board, therapy services, nursing care, medication, and medical supplies. Medicare Part C plans often have network guidelines and restrictions that must be adhered to when accessing medical services. Out-of-pocket costs are different for each type of plan.
Medicare Part C does include coverage for:
• Emergency or observational services
• Ambulance services
• Lab tests
• Primary and specialist doctor visits
• Durable medical equipment
• Preventative vaccines and tests
• Diabetes supplies and equipment
• Language and speech pathology
• Occupational therapy
• Acupuncture for chronic low back pain
The coverage and limitations of an enrollee depend on the plan they select. If you choose Medicare Part C, you will typically have different coinsurance, copayments, and deductibles than those who only enroll in Original Medicare.
Prescription Drug and Medical Coverage Combined
Medicare Part C, unlike Original Medicare, offers more comprehensive coverage that includes prescription drug insurance. With Part C, you can select a plan that combines your prescription drug and medical coverage, which eliminates the need for a separate Part D plan. This combined approach to coverage makes healthcare management easier for enrollees and ensures they have access to the medications they need. Medicare Advantage (Part C) offers a convenient solution for enrollees who prefer a single plan that covers both prescription drugs and medical expenses. The approved drugs you have access to will depend on the plan you choose, so be sure to verify your prescription drugs of choice are covered before you enroll in a plan.
Additional Medicare Part C Benefits
Medicare Part C also offers other benefits, such as
• Routine dental care, including dentures, x-rays, and cleaning
• Fitness benefits, including exercise classes and gym memberships
• Routine hearing care, including hearing aids
• Routine vision care, including eyeglasses and contacts
All Medicare Part C plans are not the same and many cover extra benefits differently.
Medicare Part C Costs
As previously stated, Medicare Part C is administered through private insurers. This means the cost of Medicare Part C will depend on multiple factors, including the plan you choose, your income level, and your location. Most Medicare Advantage plans come with their own premiums, which are in addition to the Medicare Part B premium. Some Part C plans have a $0 premium while others have premiums that cost over a hundred dollars. There may also be additional costs, such as coinsurance, deductibles, and copayments. Part C costs vary depending on the type of benefits your plan includes.
To be eligible for Medicare Part C, you must be enrolled in Medicare Part A and Part B, both of which cover hospital and medical services. You must also reside in your chosen plan’s area. Medicare Advantage plans are offered by private insurers that have specific service areas. To be eligible, you must reside in one of these service areas before you can enroll. Individuals with end-stage renal disease are not eligible to enroll in Medicare Advantage plans. Before enrolling in a plan, you should make sure you are viewing plans in your area and that the network of your chosen plan contains your doctors and medical facilities.
Paying for Medicare Part C
When you enroll in a Medicare Part C plan, Medicare will pay a fixed amount for your coverage each month. The companies offering Medicare Part C plans must adhere to certain government rules and regulations. Different costs are associated with each Medicare Advantage plan, and there are different rules for how to obtain services – some plans may require you to obtain a referral to see a specialist. Also, rules for Medicare Part C plans can change from year to year. However, your plan must notify you of any upcoming changes prior to the start of the next enrollment year. Those who enroll in Medicare Part C plans have the same protections and rights as those enrolled in Original Medicare.
Finding the Right Medicare Part C Plan
Medicare Part C (Medicare Advantage) offers many benefits Original Medicare does not. Many of these benefits are offered at little to no additional costs, and they can be an excellent resource for anyone interested in a comprehensive approach to their healthcare. There are many Medicare Part C plans available, so you should be sure to shop around first and find one that meets your healthcare needs. By taking your current health situation and budget into account, you can find the right Part C plan.