Medicare Part C
Part C is Medicare Advantage - Privately Sold Options
Medicare Part C, also known as Medicare Advantage or “Medicare Replacement”, is privately sold health insurance options that include the same coverage as Original Medicare, and more. Most Advantage plans include prescription drug coverage, and many include extra benefits like dental, vision, and hearing services, among others.
What Does Medicare Part C Cover?
Under a Medicare Advantage plan, you’re still enrolled in Original Medicare — so you get coverage for inpatient hospital stays and outpatient medical care.
However, Part C plans may offer additional benefits, like:
- Dental coverage
- Vision coverage
- Hearing aid discounts
- Housekeeping
- Meals
- Transportation
- Gym memberships
- Prescription drug coverage
What Does Medicare Part C Cost?
Medicare Advantage plans typically have a low monthly premium, though it may be as low as $0. The catch is that you have to play by certain rules to get coverage — you must see doctors within the plan’s network.
Your exact costs for Part C will depend on the TYPE of plan you pick. For example, common types of Advantage plans include PPOs, HMOs, MSAs, and MAPDs. Copayments or other fees might apply.
Get the right coverage at the right price.
What Is the Maximum Out-of-Pocket Limit?
With Original Medicare, there’s no out-of-pocket maximum. You must pay 20% of your services over and over. However, the government sets a standard Medicare Advantage maximum out-of-pocket (MOOP) each year. In 2021, this amount is $7,550, although it could be lower. This is a very important aspect of your plan, especially if you accrue high annual medical bills from hospital stays and doctor visits
For example, let’s say that you have $100 in doctor visit copays, $7,000 in hospital copays, and $450 in follow up care/treatment. In that case, you’ll be billed $7,550 — meaning you’ve reached your maximum out-of-pocket limit. Once this happens, your insurance will pay for any additional covered costs for the rest of the calendar year.
Who Qualifies for Medicare Part C?
To buy a Medicare Advantage plan, you have to be enrolled in Medicare Parts A and B and live in the plan’s service area.
When to Join a Medicare Advantage Plan
During select times of the year, you may join, drop, or change from one Part C plan to another. When you first qualify for Medicare, you can join an Advantage plan with OR without prescription drug coverage. This is called your Initial Enrollment Period (IEP), and it begins the three months before the month you turn 65 and ends the three months after.
The Annual Enrollment Period (AEP), is October 15 to December 7. During this time, you can join, change, or drop a Medicare Part C plan. Your coverage will kick in on January 1.
Next, the Medicare Advantage Open Enrollment (MAOEP) is from January 1 to March 31. You can switch to a different Part C plan or return to Original Medicare and enroll in a stand alone prescription drug plan, once, during this window.
Also, certain events may cause a Special Enrollment Period (SEP) where you have two months to join a Part C plan. SEPs are unique to the individual, so you should contact your Medicare insurance agent to see if you qualify.
How to Join
Since a Medicare Advantage plan is administered by private companies, you DON’T enroll at the Social Security office. The best way to join is to talk with a licensed agent like the ones at Oak Haven Insurance.
To find out if a Medicare Advantage plan makes sense for you, contact us today! We love helping our clients make informed decisions about their healthcare coverage.
