If you’re looking for more flexibility, more features and lower out-of-pocket costs for your health care, the answer could be Medicare Part C.
But what is Medicare Part C, exactly? What does it cover? What does it cost? How do you get it?
Let’s find the answers.
What is Medicare Part C?
Medicare Part C is an alternative to Original Medicare (Part A and Part B).
Medicare Part A pays for inpatient treatment at hospitals and skilled nursing facilities, as well as hospice care and home care. Medicare Part B is medical insurance that pays for doctor visits, screenings and other outpatient services and supplies.
Part C, also called Medicare Advantage, comprises Medicare-approved insurance plans sold by private companies.
What does Part C cover?
Part C plans cover the same medically necessary services covered by Original Medicare, and may include extras like dental, hearing and vision care, prescription drug coverage, fitness programs and transportation services that Part A and Part B don’t cover.
That’s why you often see the terms “all-in-one” or “bundled” in descriptions of Part C plans.
You may pay less out of pocket with a Part C plan than with Original Medicare, and those costs will have a yearly cap for Part A and Part B services.
Learn more about Medicare Part A and Part B.
What does Medicare Part C involve?
Enrolling in a Part C or Medicare Advantage plan involves shopping. There are different types of plans, each with its combination of premium, copayment, coinsurance and deductible. Medicare Advantage plans also vary by their cap on what you pay out of pocket for Part A and Part B services.
Types of plans
There are five types of Medicare Advantage Plans:
- Health Maintenance Organization
- Preferred Provider Organization
- Private Fee-for-Service Plan
- Special Needs Plan
- Medical Savings Account
- You can compare Medicare Advantage plans at Medicare.gov/plan-compare.
Network restrictions
A Medicare Advantage plan typically requires you to use doctors and hospitals in the plan’s network, and you’ll probably need a referral to see a specialist. So, before you sign up for a plan, make sure your doctor is covered or know that you have another in-network provider in your area.
And if you travel, remember, some plans don’t cover services from providers outside the plan’s network and service area.
Medicare Part C enrollment periods
There are three times when you can join a Medicare Advantage plan:
- Your Medicare Initial Enrollment Period
- Medicare Annual Enrollment Period, October 15 to December 7
- Medicare Advantage Open Enrollment Period, January 1 to March 31
What does Part C cost?
Medicare Advantage costs vary from plan to plan and state to state. You’ll want to look for the plan that fits your health needs and finances.
Plans vary in terms of premiums, deductibles, coinsurance and copayments, and if you get a Part C plan, you might have to pay two premiums.
That’s right. You’ll pay the Part C premium and the monthly Part B premium. The standard Part B premium is $170.10 a month in 2022, but it’s higher if your annual income exceeds $91,000 (individual) or $182,000 (joint).
Part B premium relief
To ease the burden of paying two premiums some Medicare Advantage plans have a $0 premium. Other plans pay all or part of your Part B premium in what is commonly called a Medicare Giveback.
Out-of-pocket caps
Medicare Advantage plans cap annual out-of-pocket costs for Part A and Part B services. After that, you pay nothing. Each plan has a different cap, but Medicare set the 2022 absolute ceiling at $7,550 for in-network services and $11,300 for combined in-network and out-of-network services.
What is the advantage of having Medicare Part C?
Medicare Advantage plans give you the same rights and protections, including appeals for denial of coverage, as Original Medicare.
They also limit your annual out-of-pocket expenses and often bundle Part A and Part B coverage with extras like dental, vision and hearing care, and a prescription drug benefit.
But deciding to get a Part C plan is about more than out-of-pocket expenses. You also need to ask yourself:
- What health care services do I need, and how often do I get them?
- Do I go to a doctor who accepts assignment, meaning they accept the Medicare-approved amount as full payment?
- Does the plan offer extra benefits, and do I need to pay more to get them?
Is Medicare Part C necessary?
The short answer is no. You don’t have to sign up for Part C.
Original Medicare (Parts A and B) provides hospital and medical benefits, and if you add a Part D (prescription drug) plan and Medigap coverage, you’re further protected from out-of-pocket expenses.
But, you might find that a Part C plan fits your life and circumstances better than Original Medicare by allowing you to pay for the health care you use most often.
Part C plans cover Original Medicare benefits, as well as extras like prescription drugs, vision care and even fitness programs. Part C plans may also have lower out-of-pocket expenses and you won’t have to carry gap coverage.
Learn more about Medicare Parts A, B, C and D
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com can help you find a Medicare primary care doctor near you. All of our provider partners practice value-based care, meaning Medicare rewards them for helping their patients get better. With a value-based care provider, you can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.
