Many different types of health insurance plans are offered as part of the federally introduced Medicare program and one of these is Part C plans. Here is a close look at Medicare Part C.
What Does Medicare Part C Cover?
Medicare Part C plans are also called Medicare Advantage plans and essentially provide the same coverage as Original Medicare. This includes skilled nursing facility (SNF) care and inpatient hospital care, emergency room visits, as well as medical equipment (e.g. wheelchairs) and certain vaccines such as the shingles shot if your plan covers prescription drugs. (Around 90% of Medicare Advantage plans include prescription medication or “Part D” coverage).
Additionally, some Part C plans also cover things that aren’t covered by Medicare Part A and Part B. For example, several plans also provide vision and dental care and coverage for fitness centers and hearing aids. Some plans offer additional benefits, such as daycare and home safety modifications.
Medicare Part C Network Types
Medicare Part C plans must include physicians from each medical specialty (26 in total) in their networks, as well as hospitals and chiropractic care coverage. The most common types of Medicare Advantage plans are:
- HMO or Health Maintenance Organization plans: Out of all Americans enrolled in Medicare Part C, 62% are in HMOs. These plans normally only cover services that in-network physicians perform, with the exception of emergency care services.
- PPO or Preferred Provider Organization plans: Nearly one-third (31%) of all individuals enrolled in Part C in 2019 were in PPOs. These plans often cost more because they provide more options for hospitals and doctors.
- Special Needs Plans (SNPs): If you qualify for Medicare and Medicaid, you can purchase an SNP.
- Group plans that are sponsored by unions or employers
- Other types of plans: These include Medicare Medical Savings Accounts plans (MSAs) and Private Fee-for-Service (PFFS) plans.
Who Is Eligible For Medicare Part C?
You’re eligible for Medicare if you’re over 65 and have signed up for Parts A and B. You won’t qualify for Medicare Advantage if you have end-stage renal disease (ESRD), unless you developed this condition after you had already enrolled in your Part C plan. You can also be automatically enrolled in Medicare if you’re a recipient of Social Security Disability (SSD) benefits.
What Does Medicare Part C Cost?
The cost of a Medicare Advantage plan can vary substantially depending on multiple factors, including:
Medicare Part C plans typically carry small or no monthly premiums. In 2021, the average premium for these plans is around $21.
Some Medicare plans have distinct deductibles for prescription medication and medical treatment, but not all do.
Copayments & Coinsurance
You may need to pay a copayment ($10 or $20) for every doctor’s appointment or lab visit. Coinsurance amounts to 20% of costs for Original Medicare and must typically be paid for more sophisticated medical services such as dialysis and chemotherapy.
There are two different amounts for out-of-pocket maximums for Medicare Advantage plans: $7,550 annually for in-network costs and $11,300 for in-network and out-of-network combined costs.
Contact Insured American For More
Selecting a medicare plan can still be difficult to do alone even with the given information. If you need help with selecting an ideal medicare plan for you or have further questions regarding medicare plans, contact Insured American today.