What is Medicare Part C? | MedicareHealthPlans.com

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What Is Medicare Part C?

Part C, another name for a Medicare Advantage (MA) Plan, is a part of the Medicare program that provides the same benefits as Part A and Part B as well as some additional benefits. This FAQ will answer your question “what is Medicare Part C?” by giving you the information to help you understand the benefits, costs, and coverage involved in it.

What plan options exist?

Part C combines all the benefits of Part A and Part B, but it’s contracted through private insurance companies. When selecting this type of coverage with your insurance agent, you have several different options, including the following:

  •    Health Maintenance Organization (HMO) Plans
  •    Preferred Provider Organization (PPO) Plans
  •    Private Fee-for-Service (PFFS) Plans
  •    Special Needs Plans (SNPs)
  •    HMO Point of Service (HMOPOS) Plans
  •    Medical Savings Account (MSA) Plans

Remember that the cost of your premium will vary depending on the program you select. You will continue to pay your Part B premium for your Medicare, but there may not be any additional premium required. Rather than paying the deductibles and coinsurance on Part A and B, you will have predictable copayments for hospital visits, doctor office visits and other outpatient care. You may also receive additional benefits like affordable vision, dental, and hearing coverage.

What are the out-of-pocket costs?

While your premiums are generally fixed for a full year, the out-of-pocket costs for your benefits may fluctuate. The federal government sets a maximum of $6,700 for out-of-pocket expenses1 (not including your monthly premium), but your plan’s limit may be lower. While costs vary from plan to plan, deductibles, copayments, and coinsurance are some of the factors to consider.

Your costs will vary from state to state, plan to plan, and year to year. Contact your insurer directly to find out how much you can expect to pay for covered services.

What does it cover?

MA plans cover all of the services provided by Part A and Part B. This includes hospital visits and medical costs.

Additionally, most programs offer extra coverage including some medications; hearing, dental, and vision benefits; and health and wellness programs.

It’s important to remember that hospice is not covered, nor are procedures that are deemed medically unnecessary.

How do I know if I need Part C?

It may be a good fit for you if you need the benefits of both Part A and Part B. In other words, it may be a good option if the following benefits interest you:

  •   Hospital visits
  •   Medical coverage
  •   Vision, dental, and hearing coverage
  •   Health and wellness programs
  •   Low or no premiums
  •   Low or no deductibles
  •   Preventive & screening services
  •   Medical equipment

If you have more questions, get answers from our FAQs. For more information on MA plans, see our 2017 guide here.


Sources:

1Centers for Medicare and Medicaid Services, “Strengthening Medicare Advantage

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