What Does Medicare Part C Cover?

Medicare Part C covers everything that Medicare Part A and Medicare Part B covers, but often with added benefits. This means that your hospital stays, doctor visits, skilled nursing care, hospice care and home health care are all covered under your Medicare Part C plan.

Additionally, you’ll find that many Medicare Part C plans also provide additional benefits beyond what Original Medicare covers. Some of these benefits include:

• Dental care (exams, cleanings, and X-rays)
• Hearing care (hearing tests and hearing aids)
• Vision care (exams, contacts, and eyeglasses)
• Gym memberships and fitness programs
• Medicare Food Allowance
• Prescription drug coverage
• Over-the-counter (OTC) medications
• Transportation (medical appointments)

Just keep in mind that the specific benefits offered can vary from plan to plan, so it’s important to review the details of each Medicare Part C plan before signing up.

How Much Does Medicare Part C Cost?

The cost of Medicare Part C can vary depending on the plan you choose and the area you live in. Generally, you’ll pay your regular Part B premium, plus any additional premium charged by the Medicare Part C plan. Some plans may even offer $0 premiums, but this doesn’t mean there are no costs associated with the plan.

When comparing Medicare Part C plans, consider the following costs:

• Monthly premiums: What you’ll pay for the plan itself.
• Deductibles: The amount you’ll need to pay out-of-pocket before your plan starts covering costs.
• Copayments and coinsurance: The portion of costs you’ll pay for covered services and supplies.
• Out-of-pocket maximum: The most you’ll pay for covered services during a plan year.

When it comes to comparing Medicare Part C plans, it’s best to consult with a licensed insurance agent. They can help you navigate the nuances of different plans and identify the best fit for your unique needs and circumstances.

Is a Medicare Part C HMO or PPO better?

Deciding whether a Medicare Part C plan that’s a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) is better depends on your personal preferences and healthcare needs.

HMO (Health Maintenance Organization) plans typically require you to choose a primary care physician (PCP) within the network who will coordinate your healthcare. If you need to see a specialist or receive specific services, you’ll generally need a referral from your PCP. HMOs often have lower premiums and out-of-pocket costs, but they tend to have more restrictive networks and less flexibility when it comes to choosing healthcare providers.

PPO (Preferred Provider Organization) plans offer more flexibility when it comes to choosing healthcare providers, which is particularly important if you have preferred doctors or specialists that you want to continue seeing. With a PPO plan, you can visit any doctor, specialist, or hospital, even if they’re not in the plan’s network. You also typically don’t need a referral to see a specialist. PPO plans generally have higher premiums than HMOs, but the trade-off is greater freedom in choosing healthcare providers and easier access to specialists.

Medicare Part C Eligibility

To be eligible for Medicare Part C, you must meet the following requirements:

• Be enrolled in both Medicare Part A and Part B.
• Live in the service area of the Medicare Part C plan.
• Not have end-stage renal disease (ESRD), with some exceptions.

It’s important to note that while most people with Medicare are eligible for Part C, some plans may have additional eligibility requirements or restrictions. Speak to a licensed insurance agent for more information about Medicare Part C and whether it’s the right choice for you.

Medicare Part C Enrollment Deadline

The enrollment deadline for Medicare Part C depends on your current Medicare status and the time of year. If you’re new to Medicare, you can enroll in a Medicare Advantage plan during your Initial Enrollment Period (IEP), which begins three months before the month you turn 65, includes your birth month, and ends three months after the month you turn 65.

For current Medicare beneficiaries, you can enroll or change your Medicare Advantage plan during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. Additionally, there’s a Medicare Advantage Open Enrollment Period (OEP) from January 1 to March 31 each year, which allows you to switch between Medicare Advantage plans or return to Original Medicare if you’re already enrolled in a Medicare Advantage plan.

There may also be Special Enrollment Periods (SEPs) available in certain situations, such as moving out of your plan’s service area or losing employer-sponsored coverage. These SEPs vary in length and eligibility requirements, so it’s important to understand the specific circumstances that apply to you.

How To Sign Up For Medicare Part C

Signing up for Medicare Part C involves a few simple steps:

1. Research and compare Medicare Part C plans. Simply enter your zip code to see plans that are available in your area. You can easily filter the results by company, premium and policy type.
2. Once you find a plan that meets your needs, contact the insurance company offering the plan to enroll. You can do this by calling the company directly or visiting their website. Make sure to have your Medicare card and personal information handy when enrolling.
3. After you’ve successfully enrolled in a Medicare Part C plan, you’ll receive a new membership card and information about your plan’s benefits, coverage, and provider network.

Once you’ve taken these steps, you can enjoy the peace of mind that comes with having quality healthcare coverage that you can rely on.

Medicare Part C vs Original Medicare

When deciding between Medicare Part C and Original Medicare, consider the following key differences:

• Provider networks: Medicare Part C plans often have provider networks, which means you may need to see in-network doctors and hospitals to receive coverage. Original Medicare, on the other hand, allows you to see any provider that accepts Medicare.
• Additional benefits: Medicare Part C plans often include additional benefits not covered by Original Medicare, such as dental, hearing, vision, gym memberships, and fitness programs.
• Out-of-pocket costs: Medicare Part C plans have a yearly limit on out-of-pocket costs, providing a safety net against high medical expenses. Original Medicare has no out-of-pocket maximum.
• Prescription drug coverage: Many Medicare Part C plans include prescription drug coverage, whereas Original Medicare requires a separate Part D plan for this coverage.

By considering all these factors, you can make an informed decision that best meets your healthcare needs and preferences.

Medicare Part C vs Medigap

Medicare Supplement Insurance, or Medigap, is another option to consider when comparing coverage options. Medigap plans are designed to work alongside Original Medicare to help cover out-of-pocket costs such as deductibles, coinsurance, and copayments.

Here are some key differences between Medicare Part C plans and Medigap plans:

• Provider networks: Medicare Part C plans may have more restrictive provider networks, whereas Medigap plans allow you to see any provider that accepts Medicare.
• Additional benefits: Medicare Part C plans provide comprehensive coverage and often also include dental, hearing, vision, gym memberships, and fitness programs. Medigap plans only supplement Original Medicare coverage and don’t include these additional benefits.
• Out-of-pocket costs: Medicare Part C plans have their own cost-sharing structure, including deductibles, copayments, and coinsurance, while Medigap plans are designed to help reduce out-of-pocket costs associated with Original Medicare.
• Prescription drug coverage: Many Medicare Part C plans include prescription drug coverage as part of their overall benefits package. Medigap plans do not include prescription drug coverage, so you’ll need to enroll in a separate Part D plan if you choose this option.

Ultimately, the choice between Medicare Part C and Medigap depends on your individual needs and preferences. Take the time to evaluate the coverage, benefits, and potential out-of-pocket costs associated with each option before deciding.

How To Get Help With Medicare Part C

Don’t navigate the complexities of Medicare alone. Our licensed agents at Senior Healthcare Solutions are here to help. Call us today at 866-MEDIGAP (866-633-4427) for fast and reliable assistance from knowledgeable Medicare experts. We’re here to ensure that you have the peace of mind that comes with knowing you’re making informed decisions about your healthcare coverage. So, contact us today and let us assist you every step of the way.

Frequently Asked Questions