There is a lot of information about Part C plans online, but it’s not always easy to tell what coverage they provide. This is partly because there are so many different plans available. Also, unlike Medicare supplements, Part C plans are not standardized. As long as the insurance company provides at least the same benefits you’ll find in Parts A and B, they can choose to structure a Part C plan in many different ways.
What is Medicare Part C?
Medicare Part C is more often referred to as Medicare Advantage. The federal Medicare program authorizes private insurance companies to provide Medicare Advantage plans. The government pays the insurance companies to offer the plans to unburden themselves from some of the financial responsibility of providing healthcare coverage.
A Medicare beneficiary who enrolls in a Part C plan will no longer get their benefits from the Medicare program but the private insurance company instead. However, they are still obligated to pay the Part B monthly premium.
Insurance companies keep healthcare costs down by using managed care plans. There are several types of Medicare Advantage plans, and they all utilize provider networks. The two most common types of plans are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Each plan has its own network of providers and doctors who have agreed to participate and accept the plan’s fees for services.
What do Part C plans cover?
As we mentioned earlier, the coverage you’ll find in a Part C plan can vary significantly from one plan to the next. The only way to know what a particular Medicare Advantage plan covers is to read the summary of benefits.
There are four categories of coverage you may find in a Medicare Advantage plan.
Part C Inpatient Coverage
Part A of Medicare is hospital insurance or inpatient coverage. Since Part C plans must offer the same benefits as Parts A and B, you’ll find inpatient coverage in every Part C plan. This will include coverage for services such as:
- Inpatient hospital care
- Home healthcare
- Skilled nursing facility care
- Inpatient mental health and rehabilitation services
Your coinsurance amounts will be different than those seen in Part A, but again, they will depend on the specific Part C plan. Hospice care is covered under Original Medicare, even if you are enrolled in Medicare Advantage.
Part C Outpatient Coverage
Part B of Medicare is outpatient insurance. Again, you’ll have those same benefits in Part C. This includes services such as:
- Appointments with your primary care physician and specialists
- Ambulance transportation in emergencies
- Durable medical equipment (DME) like walkers, wheelchairs, and home oxygen equipment.
- Emergency room services
- Lab tests and x-rays
- Physical, occupational, and speech therapy
- Inpatient and outpatient mental health services
- Many vaccines and preventive services
As with inpatient services, your coinsurance or copays will be dependent on the plan.
Part C Prescription Drug Coverage
Not all Medicare Advantage plans include prescription drug coverage. If yours doesn’t, you’ll be able to enroll in a stand-alone Part D prescription drug plan.
If an Advantage plan does include prescription drug coverage, you will need to review the drug formulary. This is a list of all the medications covered by the plan and which tier they are categorized into. Drugs in lower tiers (usually common, generic drugs) will cost less than those in higher tiers (specialty, brand-name drugs).
Part C Extra Benefits
A selling point for Medicare Advantage plans is their additional benefits. Original Medicare does not include coverage for aspects of your health that are still important, like dental, vision, and hearing care. Some of the extra benefits might include:
- Routine dental care such as exams, x-rays, cleanings, and restorative treatment
- Routine vision care including exams and prescription glasses or contact lenses
- Routine hearing care, including exams and hearing aids
- Transportation to and from doctor’s appointments
- Meal delivery services
- Gym memberships, wellness programs, and workout classes
Even if a plan you are considering lists lots of extra benefits, make sure you read about the details of each one before assuming coverage. The additional benefits alone are not a reason you should choose a Medicare Advantage plan over other types of supplemental coverage.
If you want to discuss your Part C choices, our team is ready to help. Schedule a consultation with one of our licensed insurance agents to review your options and the specifics of Part C plans.