PART C - MEDICARE ADVANTAGE

Part C is Medicare Advantage. These plans combine the coverage of Parts A and B into one plan. They often include prescription drug coverage, too.

Medicare Advantage plans are offered by private insurance companies approved by Medicare. You must be enrolled in both Part A and Part B to join a Medicare Advantage plan. You’ll still be in the Medicare program, but you will receive your benefits through the plan instead of through Original Medicare.

 

What Does Medicare Part C Cover?

 

Medicare Advantage (Part C) plans combine coverage for hospital care, doctor visits and other medical services all in one plan. Plans are required to provide all of the benefits offered by Medicare Parts A and B (except hospice care, which continues to be provided by Part A). Many plans also provide prescription drug coverage and additional benefits like routine dental and eye care.

What Does Medicare Part C Cost?

 

Each Medicare Advantage (Part C) plan sets its own specific costs, but the types of costs they include are similar.

 

Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

  • Whether the plan charges a monthly premium . Some plans have no premium.

  • Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.

  • Some plans pay all or part of your Part B premium.

  • Whether the plan has a yearly deductible or any additional deductibles.

  • How much you pay for each visit or service ( copayment or coinsurance ). For example, the plan

  • may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be

  • different than those under Original Medicare .

  • The type of health care services you need and how often you get them.

  • Whether you go to a doctor or supplier who accepts assignment if:

  • You're in a PPO, PFFS, or MSA plan.

  • You go out-of-network .

  • Whether you follow the plan's rules, like using network providers.

  • Whether you need extra benefits and if the plan charges for it.

  • The plan's yearly limit on your out-of-pocket costs for all medical services.

  • Whether you have Medicaid or get help from your state.

 

How Medicare Advantage Cost Sharing Works

Most Medicare Advantage plans use a combination of deductibles, co-insurance and co-pays to share the cost of the services you use. Cost-sharing usually applies to all of the services the plan covers.

You need to read the details of each individual Medicare Advantage plan to get the full story on its costs. Most plans have network doctors and pharmacies that may offer plan members discounted pricing.