The Complications When it Comes to Medicare Part C Coverage
Here, the IHS Insurance team will help you understand Medicare Part C’s basics and why choosing the right plan is so important.
Part C Basics
Medicare Part C—also referred to as an optional Medicare Advantage or Medicare Health plan—replaces all of the benefits and coverage provided under Original Medicare. These include Part A (hospital, hospice, and skilled nursing facility care), as well as Part B (medically necessary and preventative services).
As a result, to qualify for Part C, you must first sign up for Original Medicare, which activates three months before your 65th birthday. Compared to Original Medicare, though, which is managed by the U.S. Government’s Medicare Administration, private insurance carriers administer Part C.
What does this mean for you? In short, the coverage provided under Part C can vary widely.
The good news is that this article will quickly help you understand what Medicare Part C
coverage is, how it works, the benefits and features you might encounter when shopping, and how the IHS team can help you find the best plan for your needs.
How Does Medicare Part C Coverage Work?
Medicare Part C plans work very similarly to traditional insurance: you’ll start by choosing a primary care physician from a restricted network of doctors, hospitals, and other health care providers. Typically, these providers will be part of a health maintenance organization (HMO) or preferred provider organization. (PPO).
Michael Steele, Principal Owner at IHS Insurance, emphasizes that this is much different than Original Medicare, where no networks involved.
“This is advantageous for seniors who travel or really value the freedom to see any doctor or hospital nationwide where Medicare is accepted,” Michael advises.
On the other hand, he points out that “HMO plans are the last choice for Medicare recipients if they value having a choice of providers. PPO plans are less restrictive, but still, charge exorbitant copays and coinsurance amounts if you’re out of network” (more soon).
In fact, in some instances, the care you receive might not be covered at all.
IHS Pro Tip: Some Medicare Advantage plans—those designated as private fee-for-service—may provide coverage for out-of-network providers, depending on where you live.
To view all of the available plans in your area, you can log onto the Medicare.gov Plan Finder and enter your zip code. If you already have an account, you can also log into your MyMedicare to view a list of customized plans.
Because Part C plans are privately issued, they often provide additional coverage beyond what’s offered under Original Medicare for things like prescription medications (commonly also covered under Medicare Part D), along with other vision, hearing, and/or dental benefits. There’s even potential coverage for health and wellness programs and services.
Whether you’re initially signing up for a Medicare Part C plan, or activating or changing your existing one between October 15th and December 7th each year (which then becomes effective January 1st of the following year), let’s take a more detailed at some of the extra benefits you might receive.
Which Additional Coverage Does Part C Provide?
By law, third-party Part C plans must mirror all of the coverage available under Original Medicare. Outside of this, however, the sky’s the limit when it comes to what’s available under different carriers’ plans.
Examples of extra benefits include:
- Vision – Contacts, eyeglasses, routine vision care, preventative exams, etc.
- Hearing – Hearing aids, routine hearing care, etc.
- Dental – Dentures, x-rays, regular cleanings, etc.
- Health & Wellness Programs & Services – Exercise and fitness classes, etc.
- Prescriptions – An insurance carrier may cover some prescription medications not covered under Original Medicare
How much might you expect to pay, though?
What Can You Expect to Pay For Your 2019 Medicare Part C Premium?
Medicare Advantage Plans can cost surprisingly little per month. However, it’s important to remember that between co-pays, deductibles, and co-insurance, you might have to pay a significant out of pocket amount when receiving medical care.
Like most types of health coverage, though, using an in-network Medicare doctor will typically cost significantly less than one that’s out of network.
With these details in mind, Michael advises, “We always recommend Original Medicare first over a Medicare part C plan. However, if your doctor or hospital is part of a Medicare advantage plan network and you are comfortable accepting more out of pocket exposure if you get sick, then a Medicare advantage plan PPO may be the right solution for you.
However, “we almost never recommend an HMO, unless that is all one can afford,” he says.
Why? Because “HMO plans require referrals to see specialists, and they offer no out of network benefits,” Michael explains.
“That means if you got sick and wanted to go to MD Anderson Cancer Center, for instance, they probably wouldn’t accept your HMO plan. This leaves you with fewer options to see providers of your choice, should the worst happen.”
How Can You Learn More About Your Medicare Part C Coverage?
IHS’s professional Medicare agents are licensed in Texas, Oklahoma, and New Mexico, and we’re here to help ensure that you make the right decision regarding your Part C coverage, based on your unique needs and circumstances.
Need a FREE Quote or have questions regarding Medicare Coverage? We have three convenient ways to reach us: