Decoding Medicare Part C: A Deep Dive into Medicare Advantage

Medicare Part C, also known as Medicare Advantage, is a health insurance option offered by private companies approved by Medicare. It provides an alternative way for beneficiaries to receive their Medicare benefits, often with additional coverage not available through Original Medicare.

What is Medicare Part C?

Medicare Part C, or Medicare Advantage, is a health plan choice that beneficiaries may opt for as part of their Medicare coverage. These plans are offered by private companies that have been approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

How Does Medicare Part C Work?

Medicare Advantage Plans can charge different out-of-pocket costs and have different rules for how you get services. For instance, you may need a referral to see a specialist or you may have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care. These rules can change each year.

Medicare Advantage Plans cover all the inpatient and outpatient services that Original Medicare covers, except for clinical trials and hospice services. If you enroll in a Medicare Advantage plan, Original Medicare will still help cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.

What Does Medicare Part C Cover?

Medicare Advantage plans may include routine dental care, vision care, hearing care, wellness programs, and fitness center memberships. They also cover primary care and specialist doctor visits, laboratory tests, X-rays, emergency ambulatory services, durable medical equipment, preventive tests and vaccines, and physical therapy.

Costs Associated with Medicare Part C

The costs associated with Medicare Part C can vary significantly. These costs can include premiums, deductibles, and copayments. Premiums are the amount you pay each month for your Medicare Advantage plan. This cost may vary significantly. Some could be $0, while others could have premiums over $200.

Deductibles are the amount paid out of pocket by a beneficiary before benefits begin. Only some Medicare Advantage plans have an annual medical deductible. However, many Medicare Advantage plans that include Part D/prescription drug coverage may charge another deductible for drug coverage.

Copayments or coinsurance are the portion of cost you pay for covered drugs or services like doctors’ visits. The amount varies, but copays are usually a flat fee while coinsurance is a percentage of the cost of the item/service that the patient must pay.

Should You Enroll in a Medicare Advantage Plan?

When applying for Medicare, review your coverage needs. If Original Medicare isn’t enough, you may want to consider Medicare Part C. However, it's important to understand all the pros and cons before making a decision.