What is Medicare Part C?
Do you have Medicare Parts A & B but want to get added insurance benefits? Then you may want to check out a Medicare Part C plan. Don’t know what that is? Don’t worry! This article has got you covered!
If you read our previous article on Medicare Part A, you may remember us mentioning that Ohio residents have two categories to choose their health insurance plans from. These plans are Original Medicare and Medicare Advantage.
While Original Medicare with a supplement is still a great option, now consumers have more choices than ever by obtaining part C. If you want more than the traditional Medicare coverage, you may want to get Medicare Part C.
In this post, we’ll cover everything you need to know about the Medicare Part C plan, its eligibility, and coverage. So, let’s get started!
What is a Medicare Part C Plan?
A Medicare Part C plan falls into the category of Medicare Advantage. This plan covers a broader range of healthcare services than the Medical Original Plans A and B.
Medicare Part C plan covers things that Original Medicare doesn’t. This includes exercise programs (such as gym memberships or coupons) and vision, hearing, and dental services.
Furthermore, your Part C plan can also include additional advantages. For example, your plan may include transportation to doctor appointments, over-the-counter medications, and services that improve your health and wellness.
You can get a Medicare Part C plan from any private insurance company contracted with Medicare. Medicare pays the firms that offer Medicare Advantage Plans a certain sum for your treatment every month.
However, a Medicare Part C plan for individuals can charge different prescription drug costs. Moreover, they may have different rules for getting services (such as whether you need a referral to see a specialist or if you can only get non-emergency or non-urgent care from doctors, facilities, or suppliers who are members of the plan). Each year, the rules may change.
Before enrolling in Medicare Part C, check with the plan to see what benefits it offers, if you qualify, and if there are any restrictions. You can ask the company to design customized packages to include particular benefits for chronically ill participants. These packages will consist of benefits that are tailored to cure specific ailments. Most of them feature Medicare Drug Coverage (Part D).
What is the Eligibility Criteria to Receive Medicare Part C Healthcare?
Before opting for a Medicare Part C plan, you must ensure whether you are eligible for the plan or not. The eligibility criteria for Medicare Part C are listed as follows:
- You must behave subscribed to Medicare Parts A and B.
- You must live in a Medicare Advantage insurance provider’s service region that offers the coverage/price you want and accepts new subscribers during your enrollment period.
What is Medicare Part C and D?
Part C – An Overview
The majority of Medicare Advantage programs function like private insurance plans, with options such as:
- Plans for the Health Maintenance Organization (HMO)
- Strategies for Preferred Provider Organizations (PPO)
- PFFS (Private Fee-for-Service) plans
Your insurance company must follow Medicare’s guidelines. However, the restrictions for out-of-pocket expenses and access to services may differ for each plan. Your insurance company can amend the Medicare Part C plan rules each year.
There is no monthly premium for the Medicare Part C plan. However, you will have to continue paying your Part B premium to the federal government. Other than that, you will have to pay a monthly premium to your private insurance company to continue receiving the benefits.
How to Know if Medicare Part C Is the Right Option for You?
Many people become double-minded about whether they should enroll in the Medicare Part C plan or not. Here are some self-evaluation questions that can help you make the decision:
- Do you need additional services than the Medicare Parts A and B cover?
- Do your annual dental, vision, or hearing exam bills add up to a lot, and do you want coverage for them?
- Would you prefer a plan that covers all the benefits and is more convenient?
If your answers to these questions indicate that you need a Medicare Part C plan, you can go for it! But before you do, ask yourself another question: do I need prescription drug coverage too? If the answer is positive, you should get a Medicare Part C that includes the benefits of Part D as well.
What Is Medicare Part C Used for?
Part C covers both primary and advanced healthcare expenses. This Medicare Advantage plan includes both hospital insurance and medical insurance.
So, if you want to replace your Medicare Part A and B with a more convenient health insurance plan, Medicare Part C is perfect for you.
What Does Medicare Part C Cover?
Here comes the most crucial topic of this article – what benefits do you get when you subscribe to a Medicare Part A plan? The benefits that you get from a Medicare Part C plan fall into two categories: inpatient coverage and outpatient coverage.
Medicare Part C Inpatient Coverage
The inpatient services you get from this portion of Medicare resemble those of Part A Medicare. These services include:
- Inpatient hospital care
- Mental health services
- Inpatient Rehabilitation Services
- Hospice care
- Home healthcare services
- Stays in a skilled nursing facility
1. Inpatient Hospital Care
When a doctor suggests that you get hospitalized, Medicare Part C will cover your inpatient hospital care expenses. This will include meals, general nursing, semi-private rooms, and drugs and supplies necessary for treatment.
2. Inpatient Medical Health Services
All your medical expenses that occur during your inpatient hospital stays will be covered under your Medicare Part C plan. You will receive basic facilities such as standard nursing care, inpatient therapy, and lab testing.
3. Inpatient Rehabilitation Services
If a person develops an acute illness, undergoes a physically damaging accident, or gets addicted to drugs, they will be entitled to receive inpatient rehabilitation services as a part of their Medicare Part C plan. These services would include occupational therapy, physical therapy, psychological services, and social services.
4. Hospice Care
Terminally ill patients who have a life expectancy of fewer than six months receive hospice care to make their remaining life comfortable. You will continue to receive hospice care with your Medicare Part C subscription as long as you pay your premiums.
5. Home Healthcare
Patients who require extra care due to chronic illnesses get home healthcare as a part of their Medicare Part C subscription. Under this coverage, the patient will benefit from around-the-clock professional care, home meal delivery, homemaker services, and personal care services.
6. Stays in a Skilled Nursing Facility
Medicare Part C will cover skilled nursing facility costs if your doctor declares treatment in a skilled nursing facility mandatory for you. Depending on your condition, you will get meals, medications, speech therapy, physical therapy, medical supplies, and transportation services.
Medicare Part C Outpatient Coverage
The outpatient services you get as a part of your Medicare Part C subscription involve all the Part B benefits and some extra coverage. These services include:
- Doctor’s appointments
- Emergency ambulance transportation services
- Durable medical equipment, for example, wheelchairs and home oxygen equipment
- Emergency room care
- Lab testing such as blood tests
- Occupational therapy
- Physical therapy
- Speech therapy
- Image testing, for example, MRIs, X-rays, and CT scans
- Mental health counseling
- Vaccinations for flu, hepatitis B, and pneumococcal disease
- Cardiovascular disease screening
- Tobacco use cessation counseling
- Yearly wellness visits
- Bone mass measurements
- Lung cancer screening
- Obesity screening
- Limited outpatient prescription drugs, etc.
Other than these services, you can also avail of additional coverage by contacting your private insurance company. You can get customized plans covering basic healthcare expenses like vision exams and hearing exams. You can even get coverage for prescription eyeglasses, contact lenses, and hearing aids.
Part D – An Overview
Medicare Part D is a Medicare-approved commercial insurance company’s outpatient prescription medication plan. People can subscribe to a standalone Medicare Part D plan or a plan that includes Medicare Part C, for example, the MAPD plan.
You will pay a monthly premium like Original Medical Part B in a standalone Medicare Part D plan. Moreover, your insurance company will decide which medicines it would cover in your plan.
When a person enrolls in a solo Part D plan, they must pay a monthly premium based on the insurance company’s estimated costs. Usually, the individual must pay around 25% of the cost of medicines, with Medicare Part D funding the remaining 75%.
However, if a person’s “catastrophic coverage” amount is reached, they must pay 5% of the cost of medicines. This is the point where an individual’s annual prescription drug costs exceed the maximum limit ($6,550 as of 2021). This characteristic of the plan assists people who have high out-of-pocket medication costs.
What is a Donut Hole in Medicare?
A coverage gap exists in most Medicare medication plans (also called the “doughnut hole”). A doughnut hole occurs when the cost of services that you have utilized exceeds your coverage limit. In simpler terms, a doughnut hole means that the drug plan’s coverage for pharmaceuticals is temporarily limited.
The coverage gap will not affect everyone. After spending a specific amount on covered drugs from your Medicare plan, the coverage gap begins. You’ll be in the coverage gap once your spending has exceeded $4,430 on approved medication from your Medicare plan in 2022 ($4,130 in 2021). This number is subject to vary each year.
However, your coverage limit will expand if you have a Part C subscription and are still paying a Part D premium. This means you won’t enter the coverage limit exceeding the standard amount.
Conclusion on Benefits
Medicare Part C plan is a smart alternative to Original Medicare. It involves the benefits of both these plans and offers additional benefits.
So, if you want to get the opportunity of customizing your plan type, cost, and coverage, the Medicare Part C plan is perfect for you!