Medicare Part C Coverage
The Centers for Medicare & Medicaid Services is the part of the U.S.Health and Human Services tasked with administering national healthcare programs including Medicare. The agency also contracts private insurance companies to sell Medicare products like Medigap/ Medicare Supplement plans and Medicare Advantage plans also known as Medicare Part C.
When seniors get to 65 and their Original Medicare cover kicks in, they are often faced with the decision of either supplementing it with a Medigap plan or getting Medicare Part C coverage.
What Do You Get Covered With Medicare Part C
Medicare Part C plans include Original Medicare coverage for the hospital (Part A) and outpatient (Part B) medical expenses. They work as alternatives to Original Medicare in this regard and packaged as high-coverage plans, they also help seniors pay for more medical expenses.
Medicare Supplement plans complement Original Medicare to help seniors shoulder their massive out-of-pocket expenses. While Medicare covers seniors’ hospital and outpatient expenses, it still leaves a lot of expenses out of the scope of coverage. The plan also comes with annual deductible amounts as well as copays and coinsurance costs. That is where Medicare Supplements pick up and help seniors cover these costs.
Medicare Advantage plans do the same and they essentially take care of more medical expenses on top of offering Part A and B coverage. For instance, most Advantage plans also include Medicare Part D. This handles seniors’ prescription pills needs, and typically with all the other Medicare products you would have to purchase this cover as a standalone plan.
Medicare Part C Coverage works much like group insurance benefits offered through employers. They come with a network of coverage where beneficiaries can seek medical services, and this list differs from one insurer to the next. Advantage plans, copays on ambulance services, surgeries, doctor’s visits, urgent care, and hospital stays are still payable.
Best Medicare Advantage Plans
What Does Medicare Part C Cost?
Medicare Part C plans are typically referred to as high-coverage plans and they are also low-cost in most cases. They come with lower monthly premium rates than other Medicare products. The reason is because they are network-based and they also come with copays.
Health Maintenance Organization Advantage covers provide full coverage for beneficiaries strictly within the network. Your primary physician should be within the network and referrals are also made by doctors within the network to in-network specialists or healthcare professionals.
Preferred Private Organization Part C plans partially cover beneficiaries for their off-network medical costs while still offering in-network full coverage. The Private Fee For Service Medicare Advantage plans takes a more liberal approach allowing beneficiaries to seek healthcare services off-network on a co-pay model.
Depending on the type of Advantage plans, beneficiaries might end up paying $0 premiums but it does not mean that beneficiaries do not pay anything for the cover. As mentioned before, there are still co-pays, deductible, and coinsurance costs to pay.
Insurance providers can also make changes to the premiums, drug formulary, copays, and benefits annually. The reason is because just like your plan lapses annually and you can choose to renew it or not, the insurer also goes through the same process with the Centers for Medicare & & Medicaid Services. If they comply with the regulations set by the governing body, then CMS will allow them to keep on selling Advantage plans but they must restructure the basic coverage as instructed.
Out-Of-Pocket Medicare Expenses
CMS also sets the highest allowable out-of-pocket (OOP) amount that insurance providers can set for Medicare Part C coverage. For instance, for this year (2020) the amount is $6,700 for Paet A and B. Worth noting is that the deductible on parr D is a separate amount.
This is an important aspect to have in mind when signing up for a Medicare Advantage plan because it essentially lets you know how much you will have to pay before the cover kicks in. A high deductible is not necessarily a bad thing, because in most cases, such plans come with the lowest payable monthly premiums.
Also, the OOP cap is another difference between Medicare Advantage and Medicare Supplement plans. The cap protects you from paying huge OOP sums while in the case of supplements the insurer can set their own rates. In the case of Original Medicare, the OOP amount is set at 20% on aspects like visits to the Emergency Room and doctor’s office.
Therefore, Medicare Part C is a more affordable option for folks who want more coverage than what Original Medicare provides. The Advantage plans come with a lower cost than the rates attached to most Medigap covers.
All Medicare beneficiaries are automatically eligible to sign up for Advantage plans. This is regardless of age because there are special categories of people who can access Original Medicare coverage well before reaching the age of 65.
It is also important to understand that by signing up for Part C, you must already be receiving Medicare Part A coverage and enrolled for Part B. The outpatient coverage might kick off automatically for some people but most find that they have to pay a given amount in monthly premiums to access it.
You also enroll in a Medicare Advantage plan within the plan’s service area or network. This is another way Advantage and supplements differ as explained before.
It is best to sign up for one of these plans when you are initially eligible for Medicare. However, you might find that you can take up these plans during the Special Election Period (SEP). This is applicable in cases like when you move to another state so that you can access a plan that offers coverage within your new location. The same applies to when you are switching from an employer insurance plan to an Advantage plan.
The annual election period for Original Medicare, and hence, Medicare Advantage plans is between October 15th and December 7th each year. This is also the time when you can switch from a Medigap to an Advantage plan or from one type of Parr C cover to another.
We are just a call away if you have further questions about Medicare Part C coverage. We can help you decide which type of Advantage plan suits you best and what rates you stand to pay with different insurance providers in your specific area.
