Medicare Part C coverage supplements, and can be used to replace Original Medicare Parts A and B. Part C is regulated through the federal government’s US Department of Health and Human Services.
The traditional Medicare program allows a stipend to each Medicare Advantage Part C plan on an annual basis to be utilized for every individual who is enrolled. This is based on what you pay in a premium to your chosen plan regardless of how much health care services you have been rendered throughout the coverage year.
In many cases, people who are enrolled in a Part C plan pay less than what they would pay under traditional Medicare coverage. In order to be eligible for a Part C plan, an enrollee has to be an approved participant in the Original Medicare Plans A and B.
Some of the Medicare Advantage Part C Plans that you can choose from are as follows:
- Medical Savings Account (MSA)
- Health Maintenance Organization Plans (HMO)
- Preferred Provider Organization Plans (PPO)
- Special Needs Plans (SNPs that are usually for people under the age of 65 and considered disabled)
- HMO Point-of-Service Plans
How Much Does Medicare Part C Cost?
Medicare Part C costs vary by plan, provider, and a few other factors that will determine your monthly premium. Unlike Original Medicare, which is sponsored and administered by the federal government, Medicare Part C is sold through private insurers. However, it should be noted that Medicare does, in fact, pay insurers to cover your Medicare benefits.
What Are Part C Cost Factors?
There are Medicare Part C plans that share the same characteristics while other plans have more coverage that will result in additional Medicare Part C cost to policyholders. Here are some cost factors that have to be considered, as well as some that are part of the Original Medicare coverage under Parts A and B:
- Each plan must, by federal law, have all the same medical coverage as the Original Medicare Parts A and B.
- Hospice benefits are still part of the medical coverage under Medicare Part A, so they do not have to be covered under any Medicare Part C plan.
- Most of the plans offer prescription drug coverage (Medicare Advantage Prescription Drug Plan).
- A variety of plans will offer dental care, vision care, hearing aids, and physical fitness programs that cover gym membership
- Many plans cover overseas emergency medical treatment not covered through Original Medicare Parts A and B.
- The higher rated that a Part C plan is, the more likely it will offer additional benefits that lower-rated Part C plans do not offer. Utilizing a Medicare Plan Finder tool will aid in finding the best rated Part C plans with the most to offer you in medical coverage beyond the traditional Medicare coverage with far fewer out-of-pocket expense.
Medicare Part C Premiums
All Part C plans are enrolled in through private insurance companies, so the premiums vary depending upon the competitive pricing in your state, zip code, and county, which are all factors that are taken into consideration when an insurance company sets your monthly premium rate.
For a standard premium rate that will keep you within a low to moderate premium range, you must show proof of income that is below $85,000 per year. Anything above this annual salary will usually result in paying a higher monthly premium on most Part C plans. There are instances of people qualifying for as low as a $0 premium each month based on their level of income.
Premiums usually increase slightly each year, but the part C plan premiums have as a whole, decreased slightly in 2018. Weighing the advantages of the additional coverage that you receive from enrolling in a Part C plan including prescription coverage and other preventive care like dental and vision can be a deciding factor in whether a premium is proportionally advantageous for your medical needs compared to the premium cost.
Medicare Part C Out-Of-Pocket Expenses
The Medicare Part C out-of-pocket expenses are based upon a number of the following factors that you need to assess before choosing a plan:
- What is your monthly premium based on your annual salary?
- Does the plan pay for any part of your monthly Medicare Part B premium?
- Are there any annual deductibles that need to be satisfied before coverage begins?
- Are there additional hidden deductibles for special services?
- How much will you be responsible for paying for each doctor visit?
- Are there separate copays and coinsurance costs for medical services that are different than the Original Medicare?
- How often do I need certain medical services and are they covered in full?
- Is there a penalty for going to a provider who is out-of-network or is it still covered under Parts A and B?
- Is there an annual limit on the Medicare Part C out-of-pocket expenses and is it affordable?
Keep in mind that each Part C plan regulates its own coinsurance as well as deductibles. Most of the plans will provide you with a network of medical professionals to choose from so that you can stay in network and avoid additional Medicare Part C out-of-pocket expense with a doctor or hospital that is not in the provider network. Most plans will require a specialist referral to avoid paying an additional fee beyond your coverage.
Additionally, there is usually a maximum Medicare Part C out-of-pocket cost for each plan that you will be aware of before you enroll that will help you to decide whether the plan is within your potential out-of-pocket cost threshold. It is also important to note that many people try to use their Medigap supplemental plans for any Medicare Advantage Part C out-of-pocket expenses that they may incur. This will not work, nor is it allowed through Medicare. The Part C plans and the Medigap supplemental plans are specifically designed to work independently of one another.
Can the Cost of Medicare Part C Change?
Each Part C plan set their premium, deductible, and medical service costs annually. This means that Medicare does not have a say in whether any of these components are set at a higher rate, but what you are paying as a premium each year cannot be changed until the following calendar year beginning on January 1st.
