WHAT IS MEDICARE PART C: Medicare Advantage Plans & Costs

medicare part c
Table of Contents Hide
  1. What is Medicare?
  2. Medicare Part A
  3. Medicare Part B
  4. Medicare Part C (Medicare Advantage)
  5. Medicare Part D
  6. What does Medicare Part C cover?
  7. Medicare Part C Coverage
    1. Inpatient Coverage under Medicare Part C
    2. Outpatient coverage under Medicare Part C
  8. How much do Medicare Advantage (Part C) Plans Cost?
    1. Premiums
    2. Deductible
    3. Copayments
    4. Coinsurance
    5. Maximum Out-of-Pocket
  9. Medicare Part C Cost in Different States
    1. New York
    2. Atlanta, Georgia
    3. Dallas, Texas
    4. Chicago, Illinois
    5. Los Angeles, California
  10. In comparison to Original Medicare, what does Medicare Part C cover?
  11. Do you qualify for Medicare Part C?
  12. What you need to know about Medicare Enrollment
  13. Should I sign up for a Medicare Advantage Plan?
    1. Are your chosen hospitals or doctors covered by a Medicare Advantage plan?
    2. What prescription medications are covered?
    3. What are the most expensive out-of-pocket expenses?
  14. What are the Medicare Part C plans available?
    1. HMO plans for Medicare Advantage
    2. PPO plans for Medicare Advantage
  15. Is Medicare Part C required for you?
  16. How to Sign Up for a Medicare Part C Plan
  17. Can You Help Someone Apply?
    1. #1. Coverage type.
    2. #2. The type of plan.
    3. #3. Out-of-pocket expenses
    4. #4. Medical Situation.
    5. Other considerations. A research study
  18. What is the Difference between Medicare Part C and Part D?
  19. Where to Begin When Shopping for a Medicare Part C Plan
    1. Where should you begin?
    2. Providers of Medicare Advantage
    3. What should you think about?
  20. When will you be able to sign up?
  21. Medicare Part C FAQ’s
  22. What is the difference between Medicare Part C and Medicare?
  23. Which two Medicare plans Cannot be enrolled together?
  24. What is the red white and blue card?
  25. Related Articles

Medicare Part C, or Medicare Advantage, plans are available from private health insurance firms. These are options to traditional Medicare. These plans must provide at least the same basic coverage as original Medicare, but they may also provide prescription medication, vision, hearing, and wellness services.
This page will provide you with a general understanding of Medicare. It will also look at the various Medicare Advantage plans that are available, as well as enrollment and costs. Medicare Advantage plans, also known as Medicare Part C plans, are comprehensive plans that cover all of the benefits of Medicare Parts A and B as well as supplementary coverage. This is critical if you require more than what Original Medicare gives. We’ll also look at the difference between medicare part C and part D.

What is Medicare?

Medicare is a government-funded healthcare insurance program for Americans.

Medicare has four parts:

  • Part A covers hospitalization.
  • Part B covers medical expenses.
  • The Part C, also known as Medicare Advantage, is an alternative to traditional Medicare (parts A and B).
  • Part D covers prescription medications.

Medicare Part A

Original Medicare Part A offers coverage for inpatient care in a hospital, mental health unit, or skilled nursing facility. Part A also includes coverage for home health and hospice care.

Most persons do not have to pay a monthly premium for Part A because they paid Social Security taxes for 40 quarters while working. However, if a person does not pay taxes for at least 40 quarters, they must pay a monthly premium of up to $471.

In 2022, each individual must also pay a $1,484 yearly deductible for every benefit period, as well as a copay.

Medicare Part B

Medicare Part B provides preventive services as well as medically essential treatments. Coverage includes visits to a primary care physician, therapy services, and diagnostic testing.

Part B also covers emergency room visits when the patient is not admitted to the hospital.

Part B costs in 2022 include a typical monthly premium of $148.50, an annual deductible of $203, and a 20% coinsurance.

Medicare Part C (Medicare Advantage)

Medicare Part C, sometimes known as Medicare Advantage, is a supplement to original Medicare (parts A and B). The plans must provide at least the same basic coverage as original Medicare and may include additional benefits such as dental, eye, or hearing care.

Prescription drug coverage is frequently included in Medicare Advantage plans.

Medicare Part D

Medicare Part D plans, which cover certain prescription medicine costs for persons with original Medicare, are also offered by private health insurance firms.

These plans make use of a formulary, which is a list of pharmaceuticals that are covered. For prescription prescriptions, a person will pay a monthly premium, a deductible, and a copay or coinsurance.

The cost of costs varies, but the average premium for Medicare Part D in 2022 is roughly $30.50, according to the Centers for Medicare & Medicaid Services (CMS).

  • Original Medicare covers Part A (hospital services) and Part B (medical services) (outpatient medical services).
  • Part C of Medicare provides coverage for Parts A and B, as well as additional items and services. Prescription medicines, dental care, and vision care are just a few examples.

What does Medicare Part C cover?

Medicare Part C coverage must offer at least the same core government services as original Medicare. Among these services are:

  • Hospitalizations and treatments in an inpatient setting
  • Only a few days at a skilled care facility
  • Hospitalization for rehabilitation
  • Home healthcare services are limited.
  • Hospice
  • Doctor’s appointments
  • X-rays, blood tests, and laboratory testing
  • Long-lasting medical equipment
  • Services for mental health
  • Transportation for emergency ambulances
  • Preventative medicine

In addition to these essential coverage items, medicare advantage (Part C) plans include the following extras:

  • Dental
  • Vision
  • Hearing
  • Prescription medications
  • Memberships to SilverSneakers or gym memberships
  • Transportation to medical appointments
  • An inpatient stay, home meal delivery is provided.

Medicare Part C Coverage

Medicare Part C insurance plans are provided by private insurance firms. These plans, often known as Medicare Advantage plans, give the same coverage as traditional Medicare but with the added benefit of additional coverage.

You are eligible for Medicare Part C if you currently have Medicare Part A and Part B.

Medicare Advantage (Part C) plans to adhere to typical insurance systems and includes the following:

  • Plans for Health Maintenance Organizations (HMOs)
  • Plans under the Preferred Provider Organization (PPO)
  • PFFS (Private Fee-for-Service) plans
  • Plans for People with Disabilities (SNPs)
  • Plans for Medicare savings accounts (MSAs)
  • Coverage under Medicare Part C

After you’ve been released from the hospital, some plans may even provide additional coverage for health-related perks like gym memberships and meal delivery services.

Inpatient Coverage under Medicare Part C

The inpatient coverage provided by Medicare Part C will at the very least be comparable to that provided by Medicare Part A. Among these services are:

  • Inpatient hospitalization
  • Services for inpatient mental health
  • Services for inpatient rehabilitation
  • Palliative care
  • Home healthcare services are limited.
  • Only a few days at a skilled care facility

Outpatient coverage under Medicare Part C

Again, your Part C plan must cover at least what you would get under Medicare Part B, which includes:

  • Appointments with doctors, including specialists
  • Transportation for emergency ambulances
  • Wheelchairs and home oxygen devices are examples of long-lasting medical equipment.
  • Care in an emergency room
  • Blood tests and urinalysis are examples of laboratory tests.
  • Therapy (occupational, physical, and speech)
  • MRIs and X-rays are examples of imaging tests.
  • Counseling for mental health
  • Flu, hepatitis B, and pneumococcal disease vaccinations

The individual plan you select will specify any additional coverage for these services. Some plans, for example, provide basic vision checks, whereas others provide allowances for prescription eyeglasses or contact lenses.

How much do Medicare Advantage (Part C) Plans Cost?

The cost and quality of Medicare Advantage (Part C) plans vary greatly. Here are some things to think about when comparing policies.

Premiums

The monthly premium for Medicare Advantage plans is typically low or non-existent. In 2022, the average Medicare Advantage payment will be $19. Premiums differ across the country. Enrollees must still pay their Medicare Part B payment ($148.50 per month in 2022, deducted from their Social Security check if they get benefits).

Deductible

You may be required to meet a deductible before your coverage begins. Some Medicare Advantage plans have different deductibles for medical services and prescription medicines, while others do not.

Copayments

Every time you see a doctor or go to the lab, you may be compelled to pay a copayment of $10 or $20. In addition, if you spend time in a hospital, you will be subject to daily copayments. Consider your medical usage to determine how much of these costs you are likely to incur.

Coinsurance

Original Medicare requires you to pay 20% of the approved costs. Many Medicare Advantage plans require you to pay coinsurance for high-cost medical services such as diagnostic imaging, chemotherapy, radiation, and dialysis, or a part of the cost for out-of-network services in some PPO plans.

Maximum Out-of-Pocket

Medicare Advantage plans must minimize your out-of-pocket expenses. In-network costs are regulated at a maximum of $7,550 a year, while in-network and out-of-network charges combined max out at $11,300.10 In Original Medicare, there is no cap on how much your 20% share of medical expenses can add up to in a terrible health year.

Medicare Part C Cost in Different States

The following are some cost comparisons for Medicare Part C plans in key cities around the United States. Prescription medicines, vision, dental, hearing, and fitness benefits are all included in all of the plans listed below. However, their prices vary.

New York

One insurance company provides an HMO plan for the following price:

  • $0 monthly premium
  • $0 health-care deductible
  • The medication deductible is $350.
  • Out-of-pocket maximum for in-network patients: $7,550
  • The copay for a primary care physician’s visit is $10.
  • $45 copay for a specialist visit

Atlanta, Georgia

One insurance company provides a PPO plan for the following price:

  • Premium $0 monthly
  • $0 health-care deductible
  • $0 medication deductible
  • Out-of-pocket maximum in- and out-of-network: $11,300
  • Copay for an in-network primary care physician visit is $5.
  • Copay for an in-network expert appointment is $35.

Dallas, Texas

One insurance firm provides an HMO plan for the following price:

  • $0 monthly premium
  • $0 health-care deductible
  • The medication deductible is $250.
  • Out-of-pocket maximum for in-network patients: $5,900
  • $0 copay for a primary care physician visit
  • Copay for a specialist visit: $40

Chicago, Illinois

One insurance firm provides an HMO Point-of-Service plan for the following price:

  • Premium $0 monthly
  • $0 health-care deductible
  • $0 medication deductible
  • In-network out-of-pocket max: $3,900
  • In-network primary doctor visit copay: $0
  • Copay for an in-network specialist visit is $40.

Los Angeles, California

One insurance company offers a PPO plan that costs:

  • Monthly premium: $89
  • Health deductible: $750
  • $0 medication deductible
  • Out-of-pocket maximum for in-network patients: $7,550
  • In-network primary doctor visit copay: $10
  • Copay for an in-network specialist visit is $40.

It’s crucial to note that these pricing estimates were taken directly from Medicare.gov and don’t include any elements particular to your case, such as how much your prescription drugs may cost or whether you receive financial help.

In comparison to Original Medicare, what does Medicare Part C cover?

Part C plans cover Parts A and B of Medicare, and many additionally provide prescription medication coverage (Part D) and other benefits not available via Original Medicare. As a result, nearly 22 million of the approximately 64 million people who applied for Medicare chose Medicare Advantage plans.
Part A and Part B comprise Original Medicare. Part A covers inpatient medical needs such as hospitalization, home care, and other inpatient medical needs. Outpatient treatment, such as doctor visits, medical testing, screenings, and preventive care, is covered under Part B.

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Many folks may require additional healthcare coverage. Original Medicare, for example, does not include prescription drug coverage. Private insurers provide Medicare Part D coverage, but there may still be areas of your healthcare where you require protection. This is where Medicare Part C plans come into play.

Do you qualify for Medicare Part C?

If you already have Medicare Parts A and B and live in the service region of the Medicare Part C provider you are considering, you are eligible for Medicare Part c

People with end-stage renal disease (ESRD) are now able to participate in a greater range of Medicare Advantage plans, according to a law passed by Congress and taking effect in 2022. Prior to this rule, if you got a diagnosis of ESRD, most plans would refuse you or confine you to a Special Needs Plan (SNP).

What you need to know about Medicare Enrollment

  • Enrollment in Medicare is time-sensitive and should begin around three months before your 65th birthday. You can also apply for Medicare in the month of your 65th birthday and the three months after your 65th birthday, though your coverage will be delayed.
  • If you missed the original enrollment period, open enrollment is held every year from October 15 to December 7.
  • The Social Security Administration website allows you to sign up for original Medicare.
  • Through Medicare’s plan finder tool, you may compare and shop for Medicare Part C plans online.

Should I sign up for a Medicare Advantage Plan?

When applying for Medicare, consider your coverage requirements. If Original Medicare is insufficient, you may wish to pursue Medicare Part C – just make sure you understand all of the benefits and drawbacks.


Pros of Medicare Part C
Cons of Medicare Part C
Provides coverage for services not covered by Original MedicareYou may have two premiums, Medicare Part B and Medicare Part C
Most Medicare Part C plans offer prescription drug coverage (Part D)Your network of healthcare providers may be smaller
Caps out-of-pocket expensesCan’t be used with employer-sponsored healthcare benefits that supplement Original Medicare

If you decide to look into Medicare Advantage plans, here are some crucial questions to consider:

Are your chosen hospitals or doctors covered by a Medicare Advantage plan?

Because providers might change on a yearly basis, it’s a good idea to double-check that your primary care physician is still on the plan once you enroll. Simply inquire when you go to the doctor.

What prescription medications are covered?

You can use our find-a-drug tool to see which drugs are covered by the plan. If you require prescriptions, you can determine whether they are available and affordable under a certain plan.

What are the most expensive out-of-pocket expenses?

To choose a plan that meets your needs, balance your budget and coverage. A lower out-of-pocket maximum may be better for peace of mind protection against unforeseen injuries or illnesses.

What are the Medicare Part C plans available?

If you have coverage through a large insurance firm, it may provide Medicare Part C plans. The following are some of the major insurance firms that provide Medicare Part C:

  • Aetna
  • Blue Cross Blue Shield of California
  • Cigna
  • HealthPartners
  • Kaiser Foundation Hospitals
  • SelectHealth
  • UnitedHealthcare
  • UPMC

There are two types of Medicare Advantage plans available, which we will discuss in detail next.

HMO plans for Medicare Advantage

Health Maintenance Organization (HMO) plans are a popular choice for folks who seek additional coverage that original Medicare does not provide. You can obtain care from your plan’s in-network healthcare experts in a Medicare Advantage HMO plan, but you will need a referral to see a specialist.

Each state plans a variety of Medicare Advantage HMO plans, including some with no premiums, no deductibles, and minimal copayments. You must be enrolled in Original Medicare to enroll in a Medicare Advantage HMO plan.

PPO plans for Medicare Advantage

Preferred Provider Organizations (PPOs) are the most common supplemental coverage healthcare plan option. Buyers have more flexibility with this type of plan.

You can go to your chosen doctors, specialists, and healthcare facilities with a PPO plan, whether or not they are in your plan’s network. PPO plans, on the other hand, charge various fees based on a list of in-network or out-of-network providers.

PPOs are particularly advantageous because they do not require a referral to see a specialist.

Is Medicare Part C required for you?

These plans are optional, but if you require more than basic hospital and medical insurance, Medicare Part C may be a smart choice.

If you are satisfied with your current Medicare coverage and only want prescription medication coverage, a stand-alone Medicare Part D plan may be the best alternative.

If you have Medicare but simply require coverage with expenditures, a Medicare supplemental insurance (Medigap) policy may be right for you.

For some people, Medicare Part C is an unnecessary expense; in this instance, looking around for Part D and Medigap coverage may help save money.

How to Sign Up for a Medicare Part C Plan

During the Initial Enrollment Period, if you are applying for Medicare for the first time, you can select a Medicare Advantage plan (IEP). This is the seven-month timeframe that contains the following:

  • When your 65th birthday is three months away.
  • The month of your 65th birthday.
  • Three months after your 65th birthday.

If you have Original Medicare, you can switch to a Medicare Advantage (Part C) plan during the Medicare Annual Enrollment Period (AEP), which runs from October 15 to December 7. If you are already enrolled in a Medicare Advantage plan, you can change to a different one during this period.

During the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, you can also alter your Medicare Advantage plan.

Can You Help Someone Apply?

Helping a family member or friend select a Medicare Part C plan can be a time-consuming process, but it doesn’t have to be. When examining plans, keep the following points in mind:

#1. Coverage type.

If your family member is looking for coverage choices that Parts A and B do not provide, try to find a plan that covers all of their needs.

#2. The type of plan.

The proper form of Medicare Part C plan for them is mostly determined by their own preferences. Plan configurations such as HMO, PPO, PFFS, SNP, and MSA should all be examined.

#3. Out-of-pocket expenses

Low income might make meeting Medicare Part C premiums, deductibles, and out-of-pocket payments challenging. Try to find rates that they can afford.

#4. Medical Situation.

Every individual has a unique health situation that should be taken into account when shopping for Medicare coverage. Consider your health, frequency of travel, and provider choices.

Other considerations. A research study

A study of over 800,000 beneficiaries discovered that criteria such as the organization’s market share and star rating were also taken into account when selecting a Medicare Part C plan.

What is the Difference between Medicare Part C and Part D?

When paired with Part D, Medicare Part C provides extra coverage for routine healthcare, including prescription drug coverage in some plans. A Medicare Advantage prescription drug (MAPD) plan combines a Part C and Part D plan.

Part D of Medicare only covers prescription drugs. If you have Original Medicare and only need a prescription drug plan, Medicare Part D is the best option. When you need more dental, vision, or prescription medication coverage, Medicare Part C plans offer more options to meet your healthcare needs.

Where to Begin When Shopping for a Medicare Part C Plan

Medicare Advantage Plans are an “all-in-one” alternative to Original Medicare, replacing Medicare Part A (hospital coverage), Medicare Part B (medical insurance), and, in some cases, Medicare Part d (drug coverage). They are offered by private insurers who have been approved by Medicare and are also called Medicare Part C or MA Plans. Most plans provide extra benefits not provided by Original Medicare, such as dental, hearing, and vision coverage. You’ll almost certainly be obliged to use doctors in the plan’s network, but your out-of-pocket payments may be reduced.

Where should you begin?

The Medicare Plan Finder tool is the ideal location to start looking for Medicare Advantage Plans (or a Part D or Medigap coverage). After you complete a few questions about your location and any financial assistance you may be receiving — such as Medicaid — the tool will show you all available plans that fulfill your criteria.

When comparing plans, you can enter the name, dose, quantity, and frequency of any drug you take on a regular basis — as well as the pharmacy where you get prescriptions filled — if you want to view drug expenses. The final list will then be filled in with your anticipated drug prices for each plan. Plan benefits, plan type, ratings, insurance provider, and drug coverage options can all be filtered. Choose up to three plans to compare side by side.

Providers of Medicare Advantage

More information on some of the biggest Medicare Advantage providers may be found below:

  • Plans for Medicare Advantage in 2022 from AARP.
  • Medicare Advantage plans from Aetna for 2022.
  • Medicare Advantage plans from Blue Cross Blue Shield.
  • Plans for Humana Medicare Advantage in 2022.
  • Medicare Advantage plans from UnitedHealthcare for 2022.
  • Medicare Advantage plans from WellCare 2022.

What should you think about?

While you may not have many Medicare Advantage options if you reside in a rural region, city dwellers may have two dozen or more possibilities. Use the following ways to narrow the field:

#1. Locate the star rating.

Medicare gathers information about Medicare Advantage Plans from member surveys, the plans themselves, and health care providers, and then assigns a star rating based on its results. “It’s based on performance on a variety of different quality metrics, such as ‘How responsive is the plan to any concerns or questions?'” says Anne Tumlinson, CEO of health care research and consulting firm ATI Advisory. The star rating ranges from 1 to 5, with 5 being exceptional.

#2. Examine the figures.

The premium for a plan and the maximum out-of-pocket cost, which is the most you’ll pay in a year for covered health care, are the two key cost concerns. “That’s usually something people are quite interested in,” Ali explains.

#3. Consider your medications.

You can enter your usual prescriptions into the Medicare Plan Finder and several private comparison sites to assist assess plan coverage and cost.

Make a list of your healthcare providers and cross-reference them. If you have a regular network of caregivers and medical institutions, you should look for a plan that includes them.

#4. Consider your preferences.

If you see specialists regularly and do not want to require a referral for each office visit, a PPO plan is a better choice than an HMO. If you use health care only infrequently and mostly see your primary care physician, an HMO may be more cost-effective.

#5. Visit the webpage for the plan.

Before you commit to a plan, visit the provider’s website to ensure you understand all of the perks — and limits. “What we’re seeing is that plans are introducing new and unique advantages, such as in-home palliative care,” Tumlinson says. Those are exciting, and if you have a need for them, they are something to think about. However, these additional benefits are frequently rather limited, so double-check the plan.

#6. Contact the carriers.

Ali goes a step further, urging consumers to contact a carrier directly if they are interested in enrolling or switching to their plan. “We believe the most accurate information comes directly from the airline,” Ali explains. “Contact those carriers if you’re interested in switching.” Do one more step of due diligence.”

When will you be able to sign up?

During the following times, you can enroll in a Medicare Advantage Plan (or switch from one to another):

  • During the first few weeks of your enrollment.
  • Every year from October 15 to December 7, during open enrollment.
  • During Medicare Advantage open enrollment, which runs from January 1 to March 31, you can switch from one MA Plan to another (but you can’t enroll in an MA plan if you don’t already have one).

If you switch plans, you will be automatically unenrolled from your previous plan when your new one begins.

If you have any questions regarding the process, call Medicare at 1-800-MEDICARE (1-800-633-4227), or visit Medicare.gov.

Medicare Part C FAQ’s

What is the difference between Medicare Part C and Medicare?

Part B covers doctor’s appointments, whereas Part A covers hospital visits. Medicare Part C, sometimes known as Medicare Advantage, is a supplement to original Medicare. It is a comprehensive package that covers medical insurance, hospital insurance, and prescription drug coverage.

Which two Medicare plans Cannot be enrolled together?

In most cases, you cannot enroll in both a Medicare Advantage plan and a Medigap plan at the same time.

What is the red white and blue card?

Everyone who enrolls in Medicare receives a Medicare card in red, white, and blue. This card contains your name and the start dates of your Original Medicare hospital insurance (Part A) and medical insurance (Part B). It will also display your Medicare number, which serves as a unique identifier in the Medicare system.

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