Understanding How Medicare Advantage Plans Work

Are you eligible for Medicare? If so, there’s a lot of information you should know to ensure that you are making the right decision for your health. Medicare isn’t a one-size-fits-all approach, meaning that different plans are suitable for different individuals.

When exploring and deciding which plan is best for you, it’s a good idea to start by fully understanding what the Medicare benefits are and what Part C Medicare or Medicare Advantage, covers compared to the other parts of the original plan.

Part A Coverage

Medicare Part A consists of hospital coverage. These Medicare benefits can be further split into four main sections, which include hospice care, short-term inpatient hospital coverage, home healthcare services (limited), and nursing facility care for short-term cases.

Part B Coverage

Medicare Part B consists of more general medical coverage. To further break this down, the five main categories for Medicare Part B benefits are outpatient and inpatient mental healthcare, prevent services, medical equipment, diagnostic testing and related services, and equipment and treatment-specific services.

What Is Medicare Part C?

A Patient Is Consulting With the Doctor

Medicare Part C, which is also known as Medicare Advantage, is another way to cover Parts A and B of the plan for those that are eligible. Part C plans are supplied by private companies that have been authorized to provide them. These companies must ensure they follow the strict rules that are in place by the government relating to Medicare.

However, these plans can vary widely, and what is actually covered within them can vary as well. For example, some Medicare Advantage plans cover Part D, whereas others do not. Some also only cover Part A and C, which means that the original plan has to be used for particular things. Hopefully, this gives you a better understanding of the common question, what is Medicare Part C?

What Does Medicare Part C Cover?

Another common question regarding Medicare Advantage is, what does Medicare Part C cover? Most importantly, Part C covers additional services that are not included with the original Medicare plan and its offered Medicare benefits. These can include the following, but keep in mind that not every Medicare Advantage plan consists of all the services listed below:

  • Gym memberships (or discount gym memberships)
  • Certain vision coverage
  • Certain hearing coverage
  • Certain dental coverage
  • Other general medical benefits

Some Part C plans are also known to cover transportation costs, that help patients get to and from their doctor or medical facility. Additionally, they can cover the cost over-the-counter medicines. At times, a Medicare Advantage plan can even cover services related to your overall health and wellbeing.

If you suffer from a chronic illness, some Part C plans that are tailored to cover those types of conditions. It is recommended to carefully check the plans offered and review what’s included. If you’re eligible for it, it’s important to also make sure to check any limitations that it may come with.

What Are the General Rules for These Plans?

Now that you have a better understanding of what Medicare Part C is, you may be wondering what are the rules for signing up? The out-of-pocket costs that are determined by the provider can vary, so it’s a good idea to check these costs before signing up for a plan.

Certain Part C plans may require you to obtain a doctor’s referral before seeing a specialist, along with additional policies like the type of facilities you’re allowed to use for non-urgent care. These restrictions are in place because some providers work within a certain network and require individuals covered by their plans to use specific in-network places.

The plans’ requirements and limitations may change and new regulations can be added. For this reason, it’s best to frequently check your plan details to prevent any surprise costs or changes from affecting your healthcare.

How Much Do Part C Plans Cost?

Now that we’ve reviewed what Medicare Part C covers, it’s time to understand the related costs.

When signing up for a Medicare Advantage plan, the costs will vary. This is because each plan provides an array of different services. In the majority of situations, patients will have to use the health care providers within the plan’s coverage. If this is the case, it’s possible that if you try to use a provider outside of the network, the plan will not apply and additional costs will occur.

So, what are Part C Medicare’s related costs?

  • Part B Premium: For those that decide to get a Medicare Advantage plan, Part B’s premium will still be required. The costs vary and have the potential to be up to a maximum of $170.10 every month. Although, certain plans of Medicare Advantage do cover a certain amount of the premium or all of it. It’s important to check this cost when selecting the right one for you.
  • Coinsurance and co-payments: The vast majority of Part C plans require payments in the form of coinsurance or co-payments as services are supplied. There could be many different cases when this may be needed, such as visiting the doctor’s office or getting a prescription refill. These rates can change and require those enrolled in a certain plan to check their guidelines.
  • Additional costs: Another monthly premium may be charged, in addition to the Part B premium. However, this is subject to change depending on the plan that you select. Keep in mind, some plans also have different deductibles for both drug and health services.

Your needs will determine how much you’ll end up paying when it comes to out-of-pocket costs. So, if you believe that you’ll be frequently claiming health services, it’s not always best to go with the most affordable option. Otherwise, you may end up spending more in the long run.

Part D and Drug Coverage

Medicare Part D Write on Document

A majority of Medicare Advantage plans that are available to eligible patients will include some form of Part D Medicare coverage, also known as drug coverage. However, if your plan does not cover prescription costs, or not to the extent that you would like, there are additional plans that can provide more drug coverage. You’ll need to check which Medicare Advantage plan offers this.

How Medigap Insurance Works with Advantage

Unfortunately, Medigap cannot be used in combination with a Medicare Advantage Plan. This means it is unusable for costs such as deductibles, co-payments, and premiums that fall under the Part C plan that you enroll in.

You Can Count on Corus Advantage

Physicians affiliated with Corus Advantage understand that every patient is different. That’s why they tailor their services to ensure that anyone who steps into their office is as comfortable as possible – especially when examining your health and discussing serious topics. Find a provider today!

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