| Tue, Jul 11, 2017 @ 09:00 AM

Medicare Part C: The Basics

Posted by Medicare Made Clear

senior man talking to doctor in officeDo you want extra benefits in addition to the coverage offered by Original Medicare (Parts A and B)—all in one plan?

Medicare Part C is Medicare Advantage. Congress added Part C to the Medicare program to give consumers more coverage choices.

Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. Plans include all the coverage provided by Parts A and B plus additional benefits not offered with Original Medicare.

Who can get a Medicare Advantage plan?

Anyone who is eligible for Medicare may choose to join a Medicare Advantage plan, if one is offered where they live. Available plans may differ from one state or region to the next.

You must be enrolled in both Medicare Part A and Part B before you can join a Medicare Advantage plan. You will still be in the federal Medicare program, but your benefits will be provided through the plan instead of through the government.

What do Medicare Advantage plans cover?

All Medicare Advantage plans are required to cover:

  • All Part A benefits, like hospital stays, skilled nursing services and some home health care (Hospice care is still covered by Original Medicare, even if you have a Medicare Advantage plan.)
  • All Part B benefits, like doctor visits, preventive screenings and outpatient care

Most Medicare Advantage plans also include prescription drug coverage (Part D). Original Medicare does not cover prescription drugs, but you can buy a separate Part D plan to get that coverage.

Some Medicare Advantage plans also include additional benefits, such as:

  • Routine dental and vision care
  • Wellness programs and gym memberships
  • Nurse helpline services

What does a Medicare Advantage plan cost?

Each Medicare Advantage plan sets its own costs. Some plans charge a monthly premium and others don’t. Most plans share costs with you through deductibles, co-pays and co-insurance. Specific costs may vary from one plan to the next.

Medicare Advantage plans are required to set an annual out-of-pocket maximum amount. This amount is the most you could be charged for your Medicare-covered health care in a year.

The most a plan can have for an out-of-pocket maximum in 2016 is $6700. A plan may set a lower maximum amount, but not a higher one.

Deductibles, co-pays and co-insurance count toward the out-of-pocket maximum. Monthly premium payments do not.

There is no out-of-pocket maximum with Original Medicare.

How do I join a Medicare Advantage plan?

You may choose to enroll in a private Medicare Advantage plan after you complete your initial enrollment in both Part A and Part B. You may also join a Medicare Advantage plan during Medicare Open Enrollment, which happens every year from October 15 through December 7.

You can find out about plans offered where you live using Medicare’s plan finder tool. Just enter your zip code and the plan finder will show you a list of available plans.

You may enroll in a plan at Medicare.gov or with the plan directly, once you are comfortable with your plan choice.

Conclusion

A Medicare Advantage (Part C) plan is an option for people who want more coverage than Original Medicare provides plus the convenience of one plan for all of their health care needs.

It’s important to look for Medicare coverage that may fit with your health care and budget needs.  Your State Health Insurance Assistance Program (SHIP) offers free counseling services, if you need help.

Related Content

Understanding Medicare Advantage Plans (video)

How to Compare Medicare Advantage Plan Costs

How to Get Dental and Vision Care Coverage When You Have Medicare

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

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