What Does Medicare Part C Cover?
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The cost of an unexpected medical emergency can be devastating without the right healthcare coverage. Original Medicare doesn’t offer everything you need, so it’s important to explore other options like a Medicare Advantage Plan. Medicare Advantage plans often cost less than traditional Medicare.
What Does Medicare Part C (Medicare Advantage) Cover?
Medicare Part C, also known as Medicare Advantage, provides an alternative way for beneficiaries to receive their Original Medicare benefits. Part C plans are offered through and managed by private insurance carriers. Since these plans are managed care plans (regulated by Medicare) they operate much like a traditional HMO or PPO.
Medicare-eligible individuals who enroll in a Part C plan receive all the same benefits provided by Original Medicare (Part A and Part B) and may include a Prescription Drug plan.
Take a closer look below at what Medicare Part C covers.
Inpatient Care
Medicare Advantage plans cover all inpatient benefits provided through Medicare Part A if you are admitted to the hospital to treat an illness or injury. These standard benefits include:
- Semi-private rooms
- Meals
- General nursing care
- Hospital services and supplies
- Medications required during hospital care
This includes inpatient care received at:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities
- Inpatient psychiatric facilities
- Long-term care hospitals
Some Medicare Advantage plans offer inpatient coverage beyond the standard benefits provided by Original Medicare including in some instances home health care.
Outpatient Care
Just like the standard inpatient benefits covered by Medicare Part A (hospital insurance), Medicare Advantage plans must cover all the standard outpatient benefits provided by Medicare Part B including medically necessary and preventive services.
These standard benefits include:
- Doctor visits (including specialists)
- Lab tests
- X-rays, MRIs, and other imaging tests
- Emergency ambulance services
- Inpatient and outpatient mental health services
- Durable medical equipment (walkers, wheelchairs, home oxygen equipment)
- Physical therapy
- Occupational therapy
- Speech and language pathology
- Preventative tests (mammograms, prostate cancer screenings, etc)
- Vaccinations for influenza, hepatitis B, and pneumococcal disease
For a full list of standard benefits covered under Medicare Part B, visit HHS.gov
Prescription Drugs
In addition to the standard benefits provided by Original Medicare, most Medicare Advantage plans also offer prescription drug coverage. This added benefit eliminates the need for Medicare Advantage enrollees to purchase a separate Medicare Part D plan.
Since Original Medicare doesn’t cover much when it comes to prescription medications, most beneficiaries will need a prescription drug plan to help cover the cost of their prescription drugs. Those who don’t enroll in a prescription drug plan when first eligible may face a costly penalty if they decide to join a prescription drug plan at a later time.
Medicare Advantage plans vary in their formularies or list of prescription drugs they cover, with some covering more generic prescription drugs than others. The costliness of the drug also varies based on where it falls within the insurance plan’s tier list; lower-tier medicines generally have much lower copays while prescriptions, like specialty drugs on higher tiers, have much higher co-payments.
When considering a Medicare Part C plan with prescription drug coverage it’s best to review multiple plans to ensure you receive the right prescription drug coverage for your specific health needs.
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What are the Differences and Similarities between Medicare Part C to Original Medicare?
When it comes to reviewing Part C and Original Medicare you can think of them as the same but also different. Medicare Part C offers all the same benefits as Original Medicare (Part A, Hospital Insurance) and (Part B, Medical Insurance) but also additional benefits like prescription drug coverage and in some cases extra benefits.
Whether you choose to enroll in Original Medicare or a Medicare Advantage plan, you will likely pay premiums, deductibles, copays, and coinsurance. However, most Medicare Advantage plans are competitive, and many plans may not have a deductible. Most Medicare Advantage plans also offer prescription drug coverage eliminating additional costs you would be required to pay to add drug coverage to Original Medicare.
The best thing about a Medicare Advantage plan is that you can rest easy knowing there’s a limit on your out-of-pocket costs. Original Medicare doesn’t offer this protection.
How to Enroll in a Medicare Part C Plan
If you’re already enrolled in Medicare Parts A and B, you can also choose to get a Medicare Advantage plan. This will give you hospital insurance, medical insurance, and a prescription drug coverage. To qualify for a desired plan, you just have to live within the plan’s service area.
Most MA plans are year-to-year, and you can only join at certain times during the year.
Medicare Advantage plan benefits change year-to-year. Depending on your personal situation, there may only be one time a year when you can switch to or join a new plan.
Get Broad Healthcare Coverage Under One Convenient Plan
Are you ready to enroll in a Medicare Advantage plan? We can help! At AGA Medicare options, we understand the importance of choosing a health plan, which is why we strive to provide peace of mind that you’ve chosen the best plan for your specific health needs.
Our unique approach is simple, we provide a full breakdown of benefits, costs, timeframes, and enrollment periods of each plan available to you (not just one) so that you can feel confident in whatever plan you choose.
Our team of highly experienced independent insurance agents have undergone hundreds of hours of training and are fully certified to help find affordable Medicare Advantage plans in your area that fit your needs.
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