Medicare Part C
Medicare Advantage is commonly referred to as Medicare Part C.
Part C is a private insurance plan that offers Part A and B coverage along with added benefits you cannot get through Original Medicare.
How do Medicare Part C plans work?
Once you are enrolled in Medicare Part A and B, you can purchase a Medicare Advantage Plan. Medicare pays the insurance company for administering your Part A and B benefits.
When you receive healthcare services, you present your Advantage Plan card as payment.
Medicare Advantage consists of several different plans, but the most common are an HMO or PPO.
Most HMO plans require you to receive your healthcare in its network and choose a primary care physician. Out-of-network visits are only allowable in cases of emergency. If you wish to see a specialist, a referral from your primary care physician is needed.
PPO plans do offer some out-of-network coverage but it will result in additional cost-sharing by you. PPO plans do not require you to choose a primary care physician or require a referral from one to see a specialist.
What additional benefits do they offer?
Outside of the Parts A and B coverage like inpatient and outpatient care, medical equipment, etc., Part C offers additional benefits like:
- Adult day-care services
- Dental
- Fitness memberships
- Hearing
- Nutrition programs
- Prescription drugs
- Over-the-counter drugs
- Services and supports for those with chronic conditions
- Transportation to doctor visits
- Vision
- Wellness programs
If you have a chronic health condition, you may also receive additional benefits specific to your situation. These could include things like meal delivery, home cleaning, education programs for your disease, visits to a nutritionist, or transportation to grocery stores.
However, benefits your plan offers may be different. Check with your Medicare insurance agent to see plan benefits.
Medicare Advantage Plans have an out-of-pocket max
One massive benefit Part C plans offer is an out-of-pocket maximum. Original Medicare does not.
In 2023, that out-of-pocket max is $8,300 for in-network services and $12,450 for out-of-network services. After you hit your limit, your Medicare Advantage plan pays 100% of any other eligible expenses you receive.
How to get a Part C plan
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