Medical coverage is one of the critical things you should have while aging. Old age comes with lots of challenges, especially when it comes to health. This is why the United States launched health insurance called Medicare. Medicare is a national health insurance program that provides medical coverage for people 65 years and above or those with disabilities. It pays for medical services, hospital stays, and some prescription drugs. If Medicare covers you, there are some other healthcare costs that you must pay.
The original Medicare typically includes parts A and B. Part A covers inpatient medical needs such as home care, hospitalization, and other needs. Part B covers outpatient medical needs such as medical tests, screenings, doctor visits, and preventive care. However, many people require more coverage to cover their medical needs. It is for these reasons that the Medicare Part C plan comes in. It is also known as Medicare advantage. Furthermore, it covers parts A and B, and Part D may also be included.
Contents
What Does Medicare Part C Cover?
A lot of people usually enroll in Medicare Part C. It is provided by a private health insurance company which includes all Medicare Part A and Part B medical benefits, with additional coverage. All of these are under one policy. With it, you are confident about the following expenses being covered:
- Nursing home care
- Hospice care
- Ambulance services
- Skilled nursing facility services
- Home health care
- Outpatient and inpatient mental health services
- Durable medical equipment
- Outpatient prescription drugs are limited.
In 2022, Medicare Part D was also included in the Medicare Advantage plans. That is, prescription drug coverage was included in Medicare Part C. Apart from prescription drugs, Medicare Advantage plans can also cover for:
- Vision care
- Dental care
- Hearing care
- Fitness and wellness programs
- Over-the-counter products
- Transportation when you visit the doctor
One of the advantages of Medicare Part C is that it can provide coverage when you are outside the United States.
Why Do you Need Medicare Part C Cover?
Medicare Part C has a lot of advantages when it comes to your health. You need it mainly because it saves you from many expenses associated with Original Medicare. It decreases your expenses. When you choose this Medical Advantage, you enjoy the following:
- One-stop shopping. All other important benefits such as prescription drugs, dental care, and vision care are included, says Medicare Advisor from Clearmatch Medicare.
- You will have potential savings. Medical advantage plans contain out-of-pocket limits that are on costs which the Original Medicare does not have.
- You get long-term care services. Original Medicare does not cover long-term care like specialized home care and meal delivery, while Medical Advantage plans to cover such.
What is not Covered in Part C?
Despite Medicare Advantage plans having some benefits, there are some things it cannot cover. That is, it does not also cover the medical needs that the Original Medicare would not cover. That is things like experimental treatments or cosmetic surgeries.
It can also deny you coverage if you have end-stage renal disease (ESRD). If you are suffering from this disease, you enroll in a special part c plan. It is called Chronic Condition Special Needs Plan (C- SNP). They are specially designed for this condition.
Who is Eligible to Take Medicare Part C?
Everyone above 65 years and above is eligible to enroll in a Medicare Advantage plan. You should also be a U.S. citizen or a permanent legal citizen. You should have lived in the U.S. legally for five or more years.
In addition, you must also be enrolled actively in Part A and Part B of Original Medicare.
What is the Cost of Medicare Part C?
Medicare Advantage plans are associated with two types. That is, premiums for coverage and costs for covered services and procedures. The main thing is that you must be enrolled for both Part A and Part B. A lot of people qualify for premium-free part A. This is based on their work history. If you are qualified for Social Security, then most likely, you are qualified for part A without paying any additional premiums.
When you are enrolled for Part B, you will pay premiums. In any case, you are qualified to get the Medicaid program for your state; then, you might get some help with some Part B premiums.
When using your Medicare Advantage plan for your medical needs in seeing a doctor or staying in the hospital, you will have to pay some out-of-pocket costs. They can include coinsurance, co-payments, and annual deductibles.
All Medicare Advantage plans have some cost-sharing elements that come through coinsurance or co-payments. However, a lot of them do not have annual deductibles. In such a case, the plan usually correctly pays those enrolled to their benefits.
The out-of-pocket costs are often smaller than what you pay under Original Medicare. They also cap the total costs each year.
A medical Advantage plan is like employer health insurance. Its co-pays, coinsurance, and deductibles are much lower than individual health insurance.
In Need of a Medicare Part C Plan?
Medicare Part C plan offers you a lot of benefits. It saves you from out of –pocket costs for your health insurance. With it, you will enjoy health coverage benefits not offered by Original Medicare.
Medicare Advantage plans have four main types that you can choose from depending on your needs. They are:
- Health Maintenance Organization Plans (HMO)
- Preferred Provider Organization Plans (PPO)
- Private Fee-For-Service Plans (PFFS)
- Special Need Plans (SNPs)
If you are sure that Medicare Part C is correct for you, you can contact a professional for help. They can help you review the available plans in your area. You can do your research by comparing their benefits.
