Medicare Advantage (Part C): Everything You Need to Know

Medicare Part C Insurance Papers With Clipboard and Pen

For those looking to understand Medicare, especially Medicare Part C, this article will explain everything you need to know – from what Medicare Part C covers to the costs involved. Unlike Medicare Part A or B, which deals with hospital services and outpatient medical services, Medicare Part C deals with all the above, as well as many more medical services and is offered by a private insurer.

Part C Medicare is also known as Medicare Advantage. It is an alternative insurance option for those who are eligible for Medicare.

What is Medicare?

Medicare is a government-backed health insurance program for those ages 65 or older and people under that age who receive disability benefits. However, it doesn’t cover all health care and medical expenses.

That’s where Medicare Advantage (Part C) comes in. This particular plan covers much more, including elements of Medicare Parts A, B, and D into one convenient plan.

So, What Exactly Does Medicare Part C Cover?

A Patient Consult With the Doctor in the Doctor’s Office

You may be wondering: what does Medicare Part C cover? The details can sometimes be vague, so let’s break it down to be easier to understand. As mentioned above, Medicare Part C covers Parts A and B, which are the basic services that are provided by the government under the original Medicare program. This includes the below services, but could also include many more services:

  • Inpatient stays at a hospital
  • Visits from a doctor
  • Various testing (Lab tests, blood tests, x-rays, etc.)
  • Transport by emergency ambulance services
  • Limited home healthcare
  • Preventative care and treatments
  • Hospice care
  • Mental health services

In addition to offering these services, Part C plans can provide many more health and wellness benefits. If you’re wondering what Medicare Part C can also cover, you can find some of those additional services below:

  • Dental services
  • Vision and hearing services
  • Prescription drugs
  • Select gym memberships
  • Transportation
  • Home delivery for a variety of meals

Benefits of Medicare Advantage Plans

With all of your medical coverage together into one plan, you should have everything you need with Medicare Advantage. In addition to this convenient all-in-one plan, many of the Part C Medicare costs associated with medical insurance are lower than those under the original Medicare plans.

And with different types of plans depending on your situation and needs, Part C can also be more flexible.

Medicare Part C Eligibility

Many people are unsure whether they qualify for Part C coverage in Florida. As long as you already have Medicare Parts A and B, and live in the same area as the specific Medicare plan provider, you are eligible.

However, there are a few things you need to know before you enroll in a Part C plan.

First of all, you should be aware that you need to apply for a Medicare advantage plan three months before you turn 65. Although you can apply for Medicare in Florida any time up to the three months after you turn 65, you will face significant delays.

If you miss this enrollment period, you will have to wait until next year. The usual period when you can enroll is from October 15 to December 7. Wondering where to sign up? Take a look at the Social Security website to sign up and find out more information on this topic.

What Is the Medicare Part C Cost?

There are varying Medicare Part C costs involved, depending on the plan chosen and the insurer. Many Medicare Advantage plans are typically paid in monthly premiums. However, a lot of plans now are available without ever having to pay monthly premiums, meaning that you would only need to pay a premium on Part B and not Part C.

Medicare Part C costs on average around 20 dollars a month, but there can be some differences depending on a few factors. The first is deductibles. Some plans offer them, which is a certain amount of money you are responsible for paying towards your Medicare Advantage plan before it begins to cover the additional costs. However, there is always a limit when it comes to the amount you have to pay.

When looking at different plans and policies, it is always a good idea to check and make sure what the maximum limits are before committing to one.

Another thing to look out for is co-payments. For visits to doctors and other specialists, you may need to pay a co-payment fee. This is a flat fee that will not change. As well as this, additional co-payments may need to be paid, especially for certain specialists and providers that exist outside of the main network that your plan falls under.

What are the Different Medicare Advantage Plans?

Many major insurance companies provide Medicare Advantage plans. For example, Aetna, Cigna, HealthPartners, and UPMC all offer Part C. But what are the main plan types?

Medicare Advantage HMO

This is one of the two main plans that you should be aware of, the other being Medicare Advantage PPO, which we will explore later in this article. Medicare Advantage HMOs are ideal for those looking for a more in-depth plan, which is not covered under the original Medicare.

There are many different options to choose from within this plan when looking for Medicare in Florida, from those with no premiums to low co-payments.

You will be able to receive the quality care you need from in-network healthcare professionals. However, a referral will be needed to see a specific specialist. Please also note that in order to go with the Medicare Advantage HMO plan, you need to be enrolled in Medicare parts A and B first.

Medicare Advantage PPO

For those looking for more coverage when healthcare is concerned, Medicare Advantage PPO is a great choice. With the HMO plan, you could only see the doctors and specialists within your plan’s network. With the PPO plan, you can see any of your preferred specialists or healthcare facilities. Although, please be aware that this plan charges differently depending on whether you use providers within your plan’s network or outside of it.

One other advantage to Medicare Advantage PPO is that a referral is not needed for booking appointments with specialists, unlike Medicare Advantage HMO plans.

Medicare Advantage PFFS

This is a particular type of plan that is provided by a private insurance company to give you all your medical and healthcare coverage. Another advantage is that you don’t need a referral to see a specialist and you have the freedom to decide whether you want to see your own doctor or someone else.

Nevertheless, the premiums involved in PFFS are much more expensive than the more common PPO and HMO plans.

Is It Necessary to Have Medicare Part C Coverage?

A Doctor Is Talking to the Elderly Patient

Part C Medicare is necessary for those who are looking for (or need) more healthcare services than the basic insurance you get with Medicare parts A, B, and D.

Talk to Medicare Experts about Medicare Part C

Medicare Part C is an optional medical insurance type for those wanting to be covered for many kinds of medical services. The costs and plans can vary, so if you want more clarification, start by talking to healthcare experts.

For those looking for advice regarding Medicare, Corus Advantage is here to help. Physicians affiliated with Corus Advantage can provide trusted specialized guidance and review the best options for you to be sure you make the right decision for your specific medical needs.

Check out our other blog posts.

5 Types of Primary Care Doctors

There are many different types of medical specialties, so understanding the difference between obstetrics and gynecology, pediatrics, family medicine, primary care, and internal medicine can ...
Read More →

6 Common Causes of Chest Pain When Lying Down

Chest pain when lying down can be a cause for concern, especially if it’s due to an underlying medical condition. However, the reasons why you ...
Read More →
Harmonizing care, plans, and providers.
Let us help get you connected.