Consolidate your coverage with a Part C Medicare plan
Looking for a Part C Medicare plan?
Medicare Part C allows private insurance companies to sell health plans that provide Medicare benefits.
Also known as Medicare Advantage, these plans are regulated by the Medicare program and can keep your medical, hospital, and prescription drug needs (based on the plan) under one umbrella.
But each plan can vary, so it’s important to make sure it provides the coverage you need before enrolling.
Want to learn more about Medicare Advantage?
This guide will break down some important considerations to keep in mind as you shop for a plan.
What’s the difference between original Medicare and Medicare Advantage?
- Original Medicare (Medicare Parts A and B) benefits are administered by the government.
- Medicare Advantage (or Part C Medicare) benefits are administered by private insurance companies.
Let’s take a closer look at each part of Medicare:
Medicare Part A
Medicare Part A is known as hospital insurance. It covers services that are considered medically necessary to treat a disease or condition you may have.
In general, Part A can cover:
- Skilled nursing facility care
- Inpatient care in a hospital
- Nursing home care (excluding custodial or long-term care)
- Hospice care
- Home health services including (but not exclusive of): physical therapy, occupational therapy, and speech-language pathology services
Medicare Part B
Medicare Part B is known as medical insurance. It covers medically necessary services needed to diagnose and treat a medical condition, as well as services to prevent or detect common illnesses at an early stage.
Part B can cover:
- Outpatient medical services
- Ambulance services, including emergency ground transportation to a critical access hospital (CAH) or skilled nursing facility when you can’t be safely transported by car or taxi
- Durable medical equipment (DME), including (but not limited to) canes, oxygen equipment, and blood sugar monitors
- Mental health services, including inpatient, outpatient, and partial hospitalization
- Second opinions before non-emergency surgery to know and understand your treatment options
- Limited outpatient prescription drugs under limited conditions
- Clinical research
Medicare Part D provides prescription drug coverage. Prescription Drug Plans can be purchased from private health insurance companies and added to Original Medicare. Each plan can vary the amount of coverage it gives to a unique list of covered drugs known as a formulary.
Medicare Part C (Medicare Advantage)
Medicare Part C (Medicare Advantage) plans are required to provide the same coverage as Original Medicare (Parts A and B).
Many Medicare Advantage plans also provide coverage for:
- Prescription drugs
- Dental care
- Vision care
- Hearing coverage
For those looking for these benefits in addition to coverage not typically provided by Original Medicare, Medicare Advantage may be a great option.
The cost of Medicare Advantage plans
However, how much you pay for your Medicare Part C plan can depend on a number of factors, including but not limited to:
- Your plan’s monthly premium rate
- Your plan’s yearly deductible
- Your plan’s copay or coinsurance fees
- Your plan’s out-of-pocket maximum limit
- If your plan pays for your monthly Medicare Part B premium
- What type of service you need and how often you receive them
- If you’re seeing a provider that works within your plan’s network
- If you have Medicaid or receive assistance from your state
If your Medicare Advantage plan doesn’t cover your Part B premium, you may have to pay two separate premiums each month.
However, this can still be a more beneficial option than paying for Part A (if you don’t quality for “premium-free Part A”), B, and D individually.
|Medicare at a Glance 2023 Costs
|These are basic original Medicare costs.1 For more specific information, contact a licensed insurance agent with HealthMarkets.
|Part B Premium
|Part B Deductible
|Part A Premium
|$0 for most people.
Or $278 or $506 each month for Part A, depending on how long you or your spouse worked and paid Medicare taxes.
|Part A Hospital Inpatient Deductible
|$1,600 deductible for each benefit period
|$0 coinsurance for each benefit period
|$400 coinsurance per day of each benefit period
|$800 coninsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
|After Day 150 Beyond Lifetime Reserve
|*or higher depending on your income
|1. Medicare.gov: Costs. (2023). Retrieved from: https://www.medicare.gov/basics/costs/medicare-costs Accessed on April 5, 2023.
Part C Medicare Plan Premiums in 2023
In 2023, the average premium for a Medicare Advantage with prescription drug coverage is $19 per month.2
Most Medicare Advantage plans offer prescription drug coverage (89%) with almost two-thirds (66%) of beneficiaries paying no premium for their plan.2 They are only required to pay their Part B premium.
4 Types of Medicare Advantage Plans
Since Part C Medicare plans are available through private health insurance companies, you have options for which type of plans you want to enroll in.
There are four types of plans from which you can choose:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs Plans (SNPs)
Let’s take a closer look at these types of Medicare Part C plans:
A Medicare Advantage HMO plan requires you to use a specific network of:
- Other providers
These plans usually have lower out-of-pocket costs and lower monthly premiums than PPO plans, and may even have no deductible.
Unlike an HMO plan, a Medicare Advantage PPO plan doesn’t limit you to its network of providers.
- While you can see any doctor you want, it may cost more to see a doctor outside of the network.
- You also don’t need a referral from a primary care physician.
These plans also often offer benefits not included with Original Medicare coverage.
Medicare Private-Fee-for-Service Plans
A Medicare Private-Fee-for-Service Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company.3
PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay:
- Health care providers
- And how much you must pay when you get care
A Medicare SNP is a type of Medicare Advantage plan that limits membership to people with specific diseases or characteristics.
The plan is uniquely tailored to their specific:
- Benefit needs
- Choice in providers
- Needed drug formulary
Typically, those enrolled in SNPs must get their health care from in-network doctors and specialists, except for emergency and urgent care.
Which type of Medicare plan is right for you?
Depending on your own unique health insurance and budget needs, there’s a type of Medicare Advantage plan that can work for you. Before enrolling, make sure that your plan has the coverage you need for your healthcare needs.
Who is eligible for Part C Medicare?
You may be eligible for Part C Medicare if the following applies:
- Enrollment in Medicare Parts A and B
- Residence in the Medicare Advantage plan’s service area
So, before you can even qualify for a Medicare Advantage plan, you must first be eligible for Medicare.
You may be eligible for Medicare if one or more of the following applies to you:
- You are 65 or older
- You have a disability and have been on Social Security benefits for two years
- You have end-stage renal disease (ESRD) or Lou Gehrig’s disease
Can you add Medicare Part C at any time?
No, you cannot add Medicare Part C at any time.
In order to enroll in a Medicare plan outside the open enrollment period, you must have a qualifying event such as:
- You have just turned 65 (or are about to).
- You moved outside your plan’s service area.
- You moved back to the U.S. from another country.
- You moved into or out of long-term care.
- You have traditional Medicare but want a supplement.
- You lost coverage from an employer.
If any of these apply to you, you can sign up for Medicare.
If you qualify for a Medicare Advantage plan and are ready to enroll, it’s important to understand Medicare’s enrollment periods.
While you may be automatically enrolled in Medicare when you become qualified, you must actively enroll in a Medicare Advantage plan.
You can enroll during specific times of the year, including:
- The Initial Enrollment Period when you first become eligible for Medicare
- The Open Enrollment Period (October 15 – December 7) when you can change your current plan for a different one
- The Medicare Advantage Open Enrollment Period (January 1 – March 31) when you can switch to another Medicare Advantage plan or return to Original Medicare.
- The Special Enrollment Period when specific circumstances occur, including (but not limited to):
- Moving to a new location
- Becoming eligible for Medicaid
- Qualifying for Extra Help with Medicare prescription drug costs
- Getting care in an institution, such as skilled nursing facility or long-term care hospital
Is Medicare Part C being discontinued?
No, Medicare Part C is not being discontinued. However, there are other types of plans that may be sold by private insurance companies to help fill “gaps” in Original Medicare called Medicare Supplements or Medigap plans.
As of January 1, 2020, Medigap Plan C is not available to those who are new to Medicare.4
How do I apply for Medicare Part C?
You can apply for Medicare Part C a number of ways, including (but not limited to):
- Visiting the plan’s website
- Filling out a paper enrollment form
- Calling the plan’s phone number
Additionally, HealthMarkets can help you compare Medicare Advantage plans online and begin the application process.
With the yearly changes affecting the cost of Part C Medicare, it’s important to make sure you have the most up-to-date information about your benefits and coverage.
Want some help figuring out your unique insurance needs to find the right Medicare Part C plan, at no cost to you. Compare plans online or talk with a licensed insurance agent today by calling (800) 827-9990.