Medicare Advantage is also commonly referred to as Medicare Part C because it is an insurance policy that combines the coverage of both Medicare Part A and B. Since it is different from an Original Medicare policy (Parts A and B), Medicare Advantage has various eligibility criteria and coverage options for potential enrollees. Those who are interested in obtaining Medicare coverage should review the options provided by these plans and the eligibility criteria that must be met before enrolling.

The Medicare Part C cost can vary since it is offered through private insurance companies and not through Original Medicare itself. These private companies must follow Medicare rules and at least provide the coverage offered in Part A and Part B. Therefore, there are different variations of policies that potential enrollees may qualify for. To find out more about how Medicare Plan C works and the different options that may be available for these bundled coverage policies, read through the following sections.

What is covered under Medicare Part C?

Medicare Advantage plans include the same coverages that are provided in Medicare Part A and Part B. These plans may also include additional coverages, which can vary based on the policy. Since these plans are provided through private companies, there are more options available to potential enrollees than the standard Medicare coverages.

To utilize Medicare Part C plans, however, it is important to note that you may be restricted to only visiting in-network medical professionals and facilities. If you seek treatment at facilities that are not in the plan’s network, you may be required to pay for these services out of pocket. However, since these plans are offered through Medicare Advantage private insurance companies and not through Original Medicare, you may have a more extensive network of providers to choose from.

Since Medicare Part C coverage includes the coverage provided through Medicare Part A and Part B at a minimum, you will have hospital coverage and medical insurance through this program. However, keep in mind, this coverage may only apply in certain conditions and through certain providers, which may be different than Original Medicare. Some of the specific services that are covered through this plan include:

• Hospital inpatient care.
• Skilled nursing facility care.
• Hospice care.
• Home health care.
• Medically necessary services.
• Preventative services.

In addition, your Medicare Advantage Part C plan may include more coverages that are not provided through Part A and B of Medicare. These additional coverages are entirely dependent on the policy you are eligible for and choose to enroll in. These additional coverages may include dental care, eye exams, long-term care or prescription drug coverage.

To learn more about what Medicare covers, download our informative Medicare guide for free!

How is the Medicare Part C cost calculated?

If you meet the Medicare Part C eligibility requirements and you attempt to enroll in this insurance program, you may be provided with a few policy options. This is because you are offered specific Medicare Advantage plans that are offered through private insurance companies. While these companies must follow all Medicare rules and provide you with Part A and B coverages, there are also additional coverages or regulations that may be provided through these policies.

Therefore, the Medicare Part C cost that you are responsible for may vary, depending on the plan options provided to you and the policy you choose. Generally, the premium that you are responsible for is determined by:

• Specific coverages included on the policy. Generally, the more coverages you obtain with your plan, the higher the premium. However, if you choose a plan that only includes Part A and B coverages without additional financial assistance, your monthly premium may be lower.
• The type of Medicare Advantage plan you choose. In addition to choosing the types of coverages you want included, you can also choose the type of plan that is right for you. Your cost may be affected by the plan’s type, such as whether it is a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan.
• Prescription drug coverage. In many cases, prescription drug coverage is included with your Medicare Part C plan. However, if you have chosen a plan that does not include this coverage, you may purchase Part D coverage through Original Medicare. Keep in mind, this may require an additional monthly premium.

In addition to this monthly Medicare Part C cost, you are also responsible for meeting the plan’s deductible, which may vary. Once this deductible is met, the plan begins to pay for your covered services. Additionally, a copayment or coinsurance may be due at the time of treatment. This total may also vary based on the type of treatment you are seeking, and the coverage provided.

Learn About Different Types of Medicare Advantage Plans

When analyzing Medicare Part C and your options for coverage, you may be eligible for different plans through private companies that work with Medicare. There are several different types of plans that may be offered by these companies and each operates differently.

HMO and PPO plans are the most common types of insurance plans offered through these private companies. With an HMO, you may be required to only visit medical providers that are in network to utilize coverage. You may also be required to choose a primary doctor and obtain referrals before visiting specialists. With a PPO, you may not be required to choose a primary doctor or obtain referrals before visiting specialists.

If you are offered different types of Medicare Part C plans, it is important to understand why they vary before choosing the one that is right for you. Some of the plan types you may be eligible to enroll in include the following:

• Private Fee-for-Service (PFFS) plans. With these plans, you can go to any Medicare-approved medical provider to seek treatment.
• Special Needs Plans (SNPs). With these plans, you must stay in network to receive covered treatment. However, prescription drug coverage is always included.
• HMO Point-of-Service (HMOPOS) plans. These are HMO plans that allow you to visit medical providers that are out of network for higher copayments or coinsurance.
• Medical Savings Account (MSA) Plans. These Medicare Advantage plans also include savings accounts, which allow you to accumulate money to use toward covered medical services.

When determining which Medicare Plan C option is best for you, it is important to weigh the costs and coverage provided for each. Additionally, you should consider whether you meet the eligibility requirements and if your preferred medical providers accept this type of coverage.

Continue exploring the different options provided by Medicare Part C in our helpful Medicare guide.