Medicare Part C

What is Medicare Part C

Medicare Part C is also known as Medicare Advantage. A Medicare Advantage Plan is a type of Health Plan administered through private insurance companies. These Medicare Advantage Plans through these private companies contract with Medicare and provide all of your Part A and Part B benefits.

Medicare Advantage Plans can be broken down in 5 basic categories:

HMO – Health Maintenance Organization
PPO – Preferred Provider Organization
PFFS – Private Fee-for-Service
SNP – Special Needs Plan
MSA – Medical Savings Account

Most Medicare Advantage Plans include Prescription Drug (Part D) coverage as well.

What is covered under Medicare Part C

Medicare Advantage Plans cover all of your Medicare Part A and Medicare Part B services and many of them also include your Medicare Part D (Prescription Drug Coverage) as well. Please refer to Medicare Part A and Medicare Part B for a list of covered services. Here is a general list of what is covered: (these are a list of general services and is not an all inclusive list)

    • Hospital care
    • Skilled Nursing Facility Care
    • Hospice
    • Home Health Services
    • Doctors Services
    • Durable Medical Equipment
    • Emergency Room Services
    • Laboratory Services
    • Chemotherapy
    • Diabetes Supplies
    • Prosthetics
    • Ambulance Services
    • Ambulatory Surgical Centers
    • Blood
    • Rehabilitative Therapies

Some Medicare Advantage Plans also cover services not provided under Original Medicare such as (these are a list of general services and is not an all inclusive list):

    • Vision
    • Dental
    • Hearing

What is NOT covered under Medicare Part C

When it comes to Medicare part C, generally speaking, anything that is covered under Medicare Part A and Medicare Part B has to be covered by Medicare Advantage Plans. Medicare Advantage companies are contractually obligated to offer you the same services; and in some cases additional services, you would receive under Original Medicare. Here is a list of services not generally covered under Medicare Part C (these are a list of general services and is not an all inclusive list)

    • Custodial Care
    • Cosmetic Surgery
    • Acupuncture
    • Meals delivered to your home
    • Homemaker services
    • Personal care

How do I qualify for Medicare Part C

There are several different ways you can qualify for Medicare. The most common requirement is if you are a US citizen and you are 65 or older. However, being a US citizen age 65 or older is not the only way you can qualify to receive Medicare benefits. You may also qualify to receive Medicare benefits if you are under the age of 65 if you meet certain requirements. Certain disabilities, permanent kidney failure and other conditions can also make you eligible for Medicare benefits. You can always call your local Social Security administration if you need further assistance with Medicare Eligibility.
As it pertains to Medicare Part C, you can enroll in a Medicare Advantage Plan if you meet the following 3 requirements:

    • You are enrolled in Medicare Part A and Medicare Part B
    • You live in the plans service area
    • You don’t have ESRD (End Stage Renal Disease)

How much does Medicare Part C cost

Most Medicare Advantage Plans in Florida do not have a monthly premium. You are still required to pay your Medicare Part B premium and also your Medicare Part A premium if you have one. Some Medicare Advantage Plans will also offer a Medicare Part B reimbursement also called a give back. In this case they will reimburse you a portion of what you pay for you Medicare Part B premium each month.

 

What you can expect to pay for services under Medicare Part C

Under Original Medicare you’re cost for services can be a little uncertain. You have yearly deductibles on top of 20% coinsurance for Part B services that you are responsible for paying. In addition to that there is no yearly “out of pocket maximum” meaning your out of pocket costs keeping adding up as long as you require services.
With Medicare Advantage Plans, the cost for services is a little more predictable. With most Medicare Advantage Plans you do not have yearly deductibles and instead of coinsurance you have co-pays for most services. What that means is instead of paying 20% for a specialist visit under Original Medicare you may only pay a $5 co-pay for that service on a Medicare Advantage Plan. In addition to that Medicare Advantage Plans have what called a “Maximum Out of Pocket” this means there is an annual limit on what you are required to pay each year for services. Once you reach that limit, the plan pays 100% of your Part A and Part B services.
If your Medicare Advantage Plan includes Prescription drug coverage the cost you pay for your medications does not count towards your maximum out of pocket. However, if your Medicare Advantage Plan includes Rx (prescription drug) coverage you may have an annual deductable that you have to meet for that.
Medicare Advantage Plans help to reduce the cost of receiving medical services, give you the peace of mind of an annual out of pocket as well as offer you benefits that aren’t covered by Original Medicare.

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