Today in the United States, there are over 20 million people who rely on a Medicare Advantage (Part C) plan for their Medicare coverage for health care. That means that one out of every three Medicare beneficiaries has a Part C policy.
You can purchase Medicare Advantage (MA), or Medicare Part C, plans from a private insurance provider that offers them. Plans differ from company to company but they all must adhere to Medicare rules, and they must be provided by a company that is Medicare-certified.
If you have been wondering how a Medicare Part C plan works and if it would fit your health insurance needs, here is some important information that may help you make an informed decision.
Who is eligible for Medicare Part C?
Anyone who is eligible for Original Medicare insurance Part A (hospital insurance) and Part B (medical insurance) is also eligible for Medicare Part C.
You are eligible for Original Medicare when you turn 65, and you, or your spouse, has worked and paid federal taxes for at least 10 years. You may also be eligible at a younger age if you have a qualifying disability and have received Social Security disability benefits (SSDI) for at least 24 months, or if you have end-stage renal disease, or Lou Gehrig’s disease.
To be eligible for enrollment in a Part C plan, you must be currently enrolled in both parts A and B of Original Medicare.
What health care coverage does Part C provide?
According to U.S. federal law, MA plans must at least provide the same health care coverage as do both Parts A and B of Original Medicare.
Most Part C plans also have prescription drug coverage (Part D), and many have extra coverage for dental, vision, and hearing care. Some plans even offer memberships to fitness programs, meal delivery programs, and discounts for over-the-counter products. Before you enroll in an MA plan, compare the plans available in your area.
Depending on your plan, you may have a local network of health care providers that you can visit within your plan’s coverage. If you wish to see a doctor or other health care provider who is outside this network, you most likely do not have coverage through the Part C plan and are responsible for 100 percent of this expense.
Most MA plan providers give you an ID card which you use for all your health care services whether at your physician’s office, in the hospital, or at our network pharmacy.
How much do you pay for your health care services with a Medicare Advantage plan?
If you have Original Medicare insurance coverage, you generally pay 20 percent of the final Medicare-approved cost for your health care services. Depending on your MA plan, you may pay copays for medical services at the time of your treatment. Or, your plan may have a coinsurance charge which is usually not more than 20 percent of the final, approved cost.
Some Part C plans also have deductibles which you must pay before the plan begins covering your health care expenses.
As with Original Medicare Part B, you may pay a monthly premium for your Part C plan. There are some companies that offer premium-free plans so make sure you ask about this and whether they have added costs elsewhere. Even if you have an MA plan, you must also continue paying your Original Medicare Part B monthly premium. This is a separate charge and is not included in your MA’s monthly premium.
Make sure to get all the details about how much your premiums and deductibles cost, whether you have copays or coinsurance, and how much they cost, before you enroll in any Part C plan.
If you have Medicare coverage with a Part C plan, you also have a yearly limit for your out-of-pocket costs for services covered by Original Medicare insurance Parts A and B. When you reach your plan’s out-of-pocket maximum, you do not have to pay for any other services covered under Original Medicare Part A or Part B for the rest of that year.
If you have an MA plan, you cannot purchase other Medicare supplemental insurance like a Medigap plan, for example.
Having Medicare coverage through a Part C plan may be a better option for your health care needs and it is worth your time to get all the details about how Medicare Part C works before you make your decision.
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