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 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 $170.10 in 2022. You may also have to pay Part C premiums, which may include prescription drug coverage.
According to KFF.org, the average number of Medicare Advantage (MA) plans available to beneficiaries for 2022 has increased to 39. Among these MA plans 31 include prescription drug coverage.
However, Original Medicare beneficiaries pay Part D premiums for prescription drug coverage. The cost of Part D vary by plan, geographic area (the state where you live), and your taxable income from the last two years. KFF projects a $43 average monthly premium for Medicare Part D stand-alone drug plans in 2022.
The maximum out-of-pocket (OOP) limit for in-network services is $7,550 excluding End-Stage Renal Disease (ESRD). The max OOP including ESRD is $8,174. 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 $7,550. 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.
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.
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.
Your Medicare Part C (Medicare Advantage Plan) includes the following types of Hospital Coverage:
When you are admitted to the hospital as an inpatient and the hospital accepts Medicare, then Part C pays for your “room and board” in the hospital. The Medicare Advantage Plan is going to pay for a semi-private hospital room with a bed for you, three meals per day, and the nurse that visits you. In addition, MA Plans pays for medications furnished to you by the hospital and any necessary lab services or medical supplies.
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:
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:
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:
The goal of home health care is to help you get better, regain your independence, and become as self-sufficient as possible.
In addition to hospital coverage, Medicare Part C includes the following Medical Coverage:
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 a number of preventive screenings. For example, your Medicare Advantage Plan covers diabetes screenings and supplies.
According to the National Diabetes Statistic Report 2020, Diabetes affected 34.2 million Americans in 2018. In other words, 10.5% of the US population had diabetes. Moreover, 11.5 million seniors ages 65 and older were diagnosed with diabetes. Therefore, it is important you know whether you are one of those millions of people who have diabetes.
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, and nerve damage.
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:
If your doctor or healthcare professional certifies you can not perform these activities, then your Medicare Advantage plan may cover mobility equipment.