What Does Medicare Part C Cover?
Medicare Advantage (Part C) is an insurance option for people who want extra coverage beyond what traditional Medicare plans cover. For example, some plans offer vision, dental, or fitness benefits.
Private insurance companies offer Part C plans, also known as Medicare Advantage plans. These plans provide the same coverage as Original Medicare (parts A and B), with the benefit of supplemental coverage.
If you already receive Part A and Part B, you’re eligible for Part C.
Medicare Part C plans follow traditional insurance structures and include:
What does Medicare Part C include?
All Part C plans cover hospital costs and medical costs, and most Part C plans also cover:
Some plans may even offer additional coverage for health-related perks, like gym memberships and meal delivery services after you’ve been released from a hospital.
Part C inpatient coverage
The inpatient coverage you’ll receive with Medicare Part C will at least match the coverage of Medicare Part A. These services include:
inpatient hospital care
inpatient mental health services
inpatient rehabilitation services
limited home healthcare
limited stays in a skilled nursing facility
Part C outpatient coverage
Again, your Part C plan must cover at least what you would get under Medicare Part B, which includes:
doctor’s appointments, including specialists
durable medical equipment like wheelchairs and home oxygen equipment
laboratory testing, such as blood tests and urinalysis
occupational, physical, and speech therapy
vaccinations for flu, hepatitis B, and pneumococcal disease
Any additional coverage for these services will be outlined by the specific plan you choose. For example, some plans offer basic vision exams, while others include allowances for prescription eyeglasses or contact lenses.
How much do Medicare Advantage plans cost?
The cost of a Part C plan will depend on a variety of factors. The most common costs within your plan will be:
your Part B monthly premium, which your Part C plan may cover
your Part C costs, which include a deductible and monthly premiums
your out-of-pocket costs, which include copayments and coinsurance
Below are some cost comparisons for Medicare Part C plans in some major cities around the United States.
The plans listed below cover prescription drugs, vision, dental, hearing, and fitness benefits. However, they differ in cost.
New York
One insurance company offers an HMO plan with the following costs:
monthly premium: $0
health deductible: $0
drug deductible: $250
in-network out-of-pocket max: $8,850
primary doctor visit copay: $0
specialist visit copay: $25
Atlanta
One insurance company offers a PPO plan with the following costs:
monthly premium: $0
health deductible: $0
drug deductible: $0
in-network and out-of-network out-of-pocket max: $11,300
in-network primary doctor visit copay: $0
in-network specialist visit copay: $20
Dallas
One insurance company offers an HMO plan with the following costs:
monthly premium: $0
health deductible: $0
drug deductible: $0
in-network out-of-pocket max: $3,800
primary doctor visit copay: $0
specialist visit copay: up to $20
Chicago
One insurance company offers an HMO Point-of-Service plan with the following costs:
monthly premium: $0
health deductible: $0
drug deductible: $0
in-network out-of-pocket max: $2,300
in-network primary doctor visit copay: $0
in-network specialist visit copay: $15
Los Angeles
One insurance company offers an HMO plan with the following costs:
monthly premium: $0
health deductible: $0
drug deductible: $0
in-network out-of-pocket max: $198
in-network primary doctor visit copay: $0
in-network specialist visit copay: $0
It’s important to note that these price estimates were taken directly from Medicare.gov and don’t include any factors unique to your situation, such as how much your prescription drugs may cost or whether you receive financial assistance.
The bottom line
Medicare Part C is an insurance option for people who want more Medicare coverage. Also known as Medicare Advantage, Part C plans give you the opportunity to choose your plan type, coverage, and costs.
You may want a Medicare Part C plan if you take prescription drugs, need dental, vision, or hearing coverage, or want additional health benefits like fitness and medical transportation.
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