What Is Medicare Part C?
Medicare Part C also called Medicare Advantage Plan (MA Plan) is offered by private companies approved by Medicare and is an alternative to Original Medicare Part A and Part B. Medicare Advantage plans can include Part D prescription drugs. Moreover, MA Plans may cover extra benefits that Original Medicare does not cover.
Medicare Part C Coverage & Cost
Medicare Part C hospital coverage includes inpatient care in a hospital and skilled nursing facility. Furthermore, it includes hospice and home health care. In addition to hospital coverage, Part C medical coverage includes doctor visits, preventive screenings, ambulance services, and durable medical equipment.
To enroll in Part C, you need to first enroll in Medicare Part A and Part B. Beneficiaries new to Medicare starting January 1, 2020 must pay Part B monthly premiums. The standard Part B premium is $174.70 in 2024. You may also have to pay Part C premiums, which may include prescription drug coverage.
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Medicare Advantage Vs Original Medicare
Premium Differences
The estimated average monthly Medicare Advantage premium in 2024 is $18.50 . According to KFF.org , “More than half of all Medicare Part D enrollees (56%) are in Medicare Advantage drug plans,” and 44% enroll in stand-alone drug plans.
Original Medicare beneficiaries pay stand-alone Part D premiums for prescription drug coverage. The cost of Part D varies by plan, geographic area (the state where you live), and your taxable income from the last two years. CMS.gov projects an average 2024 Part D premium of $55.50.
Max Out-of-Pocket Limit
The maximum out-of-pocket (OOP) limit for Medicare Advantage plans is $8,850. However, Medicare Advantage Plans limits vary from plan to plan. For example, your maximum out-of-pocket limit could be as low as $0.
In comparison, Original Medicare has no out-of-pocket limit. Therefore, the amount you pay for Medicare services may be more than $8,850. For example, you could pay $10,000 or more. To reduce your out-of-pocket expenses, we recommend you consider a Medicare Supplement (Medigap) plan .
Original Medicare offers nationwide coverage and access to more doctors and hospitals than Part C plans. However, Medicare Advantage (MA) plans offer local (HMO) or regional (PPO) network coverage.
Medicare Advantage – HMO vs. PPO
HMO (Health Maintenance Organization) plans often require referrals from your primary card physician to see a specialist. Furthermore, HMOs do not provide out-of-network coverage, unless it’s for emergency or urgent care. So, if you travel out of network and need a hospital or doctor for a non-emergency, your HMO will not cover it. Thus, HMO only covers in-network doctors and hospitals.
PPO (Preferred Provider Organization) plans allow you to see doctors outside your network, but it may cost you more.
MA Plan Extra Benefits
Medicare Advantage plans may offer you additional benefits, including: dental, vision, hearing, fitness program, and transportation. Before you join Medicare Part C, make sure you ask your doctors if they participate in MA plans.
Cost Comparisons
Premium Differences
The estimated average monthly Medicare Advantage premium in 2024 is $18.50 . According to KFF.org , “More than half of all Medicare Part D enrollees (56%) are in Medicare Advantage drug plans,” and 44% enroll in stand-alone drug plans.
Original Medicare beneficiaries pay stand-alone Part D premiums for prescription drug coverage. The cost of Part D varies by plan, geographic area (the state where you live), and your taxable income from the last two years. CMS.gov projects an average 2024 Part D premium of $55.50.
Max Out-of-Pocket Limit
The maximum out-of-pocket (OOP) limit for Medicare Advantage plans is $8,850. However, Medicare Advantage Plans limits vary from plan to plan. For example, your maximum out-of-pocket limit could be as low as $0.
In comparison, Original Medicare has no out-of-pocket limit. Therefore, the amount you pay for Medicare services may be more than $8,850. For example, you could pay $10,000 or more. To reduce your out-of-pocket expenses, we recommend you consider a Medicare Supplement (Medigap) plan .
Coverage Comparisons
Medicare Advantage – HMO vs. PPO
HMO (Health Maintenance Organization) plans often require referrals from your primary card physician to see a specialist. Furthermore, HMOs do not provide out-of-network coverage, unless it’s for emergency or urgent care. So, if you travel out of network and need a hospital or doctor for a non-emergency, your HMO will not cover it. Thus, HMO only covers in-network doctors and hospitals. PPO (Preferred Provider Organization) plans allow you to see doctors outside your network, but it may cost you more.MA Plan Extra Benefits
Medicare Advantage plans may offer you additional benefits, including: dental, vision, hearing, fitness program, and transportation. Before you join Medicare Part C, make sure you ask your doctors if they participate in MA plans.Medicare Part C Hospital Coverage
Your Medicare Part C (Medicare Advantage Plan) includes the following types of Hospital Coverage:
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Hospital Inpatient Care
Skilled Nursing Facility Inpatient Care
Hospice Care
Home Health Care
What Is Medicare Part C Coverage For Hospital Care?
Medicare Part C hospital coverage includes inpatient care in a hospital and skilled nursing facility. Furthermore, it includes hospice and home health care. In addition to hospital coverage, Part C medical coverage includes doctor visits, preventive screenings, ambulance services, and durable medical equipment.
To enroll in Part C, you need to first enroll in Medicare Part A and Part B. Beneficiaries new to Medicare starting January 1, 2020 must pay Part B monthly premiums. The standard Part B premium is $174.70 in 2024. You may also have to pay Part C premiums, which may include prescription drug coverage.
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Medicare Part C pays for skilled nursing care for a limited time at a Skilled Nursing Facility (SNF). Medicare Advantage plan covered services in a SNF include, but are not limited to:
Physical therapy
Occupation therapy
Speech-language pathology services
Medical social services
Medications
Ambulance transportation (when other transportation endangers health)
Dietary counseling
Swing bed services
Medicare Part C pays for your hospice care. When you have a terminal illness, hospice care can include any or all of the following services:
Doctor services
Nursing care
Medical equipment, such as wheelchairs or walkers
Medical Prescription drugs for symptoms control or pain relief
Hospice aide and homemaker services
Physical therapy services
Occupational therapy services
Speech-language pathology services
Social work services
Dietary counseling
Grief and loss counseling for you and your family
Short-term respite care
Medicare Part C covers home health care which includes a wide range of services administered in your home for an illness or injury. For example, skilled home health care services include:
Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status
The goal of home health care is to help you get better, regain your independence, and become as self-sufficient as possible.
Skilled Nursing Facility
Medicare Part C pays for skilled nursing care for a limited time at a Skilled Nursing Facility (SNF). Medicare Advantage plan covered services in a SNF include, but are not limited to:
Physical therapy
Occupation therapy
Speech-language pathology services
Medical social services
Medications
Ambulance transportation (when other transportation endangers health)
Dietary counseling
Swing bed services
Hospice Care
Medicare Part C pays for your hospice care. When you have a terminal illness, hospice care can include any or all of the following services:
Doctor services
Nursing care
Medical equipment, such as wheelchairs or walkers
Medical Prescription drugs for symptoms control or pain relief
Hospice aide and homemaker services
Physical therapy services
Occupational therapy services
Speech-language pathology services
Social work services
Dietary counseling
Grief and loss counseling for you and your family
Short-term respite care
Home Health Care
Medicare Part C covers home health care which includes a wide range of services administered in your home for an illness or injury. For example, skilled home health care services include:
Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status
The goal of home health care is to help you get better, regain your independence, and become as self-sufficient as possible.
Medicare Part C Medical Coverage
Doctor Visits
Preventive Screenings
Mobility Equipment
Your Medicare Part C medical coverage is for stays at any hospital or medical facility for less than 24 hours (even if your stay occurs overnight). As part of your Medicare Advantage plan, it covers medically necessary services and supplies to treat your health condition.
For example, Part C includes outpatient preventive services such as your annual flu shot and annual wellness visit to prevent illness. Furthermore, Medicare Part C covers medical screening tests such as cardiovascular disease and colorectal cancer screenings to detect your health conditions early so treatment is most effective.
Medicare Advantage plans also cover ambulance services and durable medical equipment.
Medicare Part C covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility. However, your Medicare Advantage plan will only cover ambulance service to the nearest appropriate medical facility that is able to provide for your medical needs. In addition, your MA plan may pay emergency ambulance transportation in an airplane or helicopter to a hospital if you need rapid medical transport.
Medicare Part C covers several preventive screenings. For example, your Medicare Advantage Plan covers diabetes screenings and supplies.
According to CDC.gov , diabetes affects 38.4 million Americans. In other words, 11.6% of the US population has diabetes. Moreover, 27.2 million seniors ages 65 and older have prediabetes (48.8%).
When diabetes is caught early, it can be effectively managed. However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney damage, vision disability, and lower-extremity amputation.
What is hepatitis?
Hepatitis is a medical condition that causes inflammation of your liver. You may have hepatitis and not know it because there are few or no symptoms. Therefore, it is important you get screened because hepatitis can lead to jaundice, nausea, and in rare cases death. Medicare also covers vaccines for COVID-19 and other communicable diseases, including:
Pneumococcal
Influenza
Shingles
Medicare Part C covers mobility equipment such as canes, walkers, scooters, and wheelchairs if you have a disability which prevents you from doing the following activities:
Bathing
Toileting
Personal Care
Feeding
Dressing
If your doctor or healthcare professional certifies you can not perform these activities, then your Medicare Advantage plan may cover mobility equipment.
Preventative Screening For Diabetes
Medicare Part C covers several preventive screenings. For example, your Medicare Advantage Plan covers diabetes screenings and supplies.
According to CDC.gov , diabetes affects 38.4 million Americans. In other words, 11.6% of the US population has diabetes. Moreover, 27.2 million seniors ages 65 and older have prediabetes (48.8%).
When diabetes is caught early, it can be effectively managed. However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney damage, vision disability, and lower-extremity amputation.
Preventative Screening For Hepatitis
What is hepatitis?
Hepatitis is a medical condition that causes inflammation of your liver. You may have hepatitis and not know it because there are few or no symptoms. Therefore, it is important you get screened because hepatitis can lead to jaundice, nausea, and in rare cases death. Medicare also covers vaccines for COVID-19 and other communicable diseases, including:
Pneumococcal
Influenza
Shingles
Mobility Equipment
Medicare Part C covers mobility equipment such as canes, walkers, scooters, and wheelchairs if you have a disability which prevents you from doing the following activities:
Bathing
Toileting
Personal Care
Feeding
Dressing
If your doctor or healthcare professional certifies you can not perform these activities, then your Medicare Advantage plan may cover mobility equipment.