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Medicare Part C Explained: What Does It Cover?

Medicare Part C is a private plan option for Medicare beneficiaries seeking expanded services and limited out-of-pocket costs within their health care plan. Also known as Medicare Advantage or MA Plans, Part C Plans merge Part A and B provisions with additional vision, dental, hearing, and wellness benefits.

Key takeaways:

In 2022, about half of the over 28 million Medicare beneficiaries were enrolled in Medicare Part C.

What is Medicare Part C?

Medicare Part C is an option for replacing and expanding the health care services beyond what Original Medicare provides. It is like an all-in-one plan that allows you to customize health coverage. At a minimum, Part C covers the benefits of Parts A and B. Your plan may also include Part D prescription drug coverage.

If you have Part C coverage, you don’t need and can’t keep Parts A or B.

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According to the Kaiser Family Foundation, the average Medicare enrollee can choose from 43 Part C plans, including 35 with Part D drug coverage, available in 2023. Types of Medicare Part C plans include:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)
  • HMO Point of Service (HMO-POS) Plans
  • Medicare Medical Savings Account (MSA) Plan

You can find details regarding Part C plans at Medicare.gov.

Why would I need Medicare Part C?

Although you’re still in Medicare and get full Part A and B coverage, Medicare Part C plans offer extra benefits. For instance, Medicare Advantage can cover vision, dental, and hearing services. Part C may be more affordable as out-of-pocket costs might be lower.

Further, Medicare Part C plans have a maximum on your out-of-pocket costs for the plan year. After you reach this limit, the plan pays for 100% of covered services. However, plans have different limits that can change every year.

Individuals with severe medical conditions or financial situations may benefit from joining a Part C plan called a Special Needs Plan (SNP). For instance, some SNPs cater to individuals who live in long-term care facilities. Other SNPs are designed for those who are dual eligible for Medicare and Medicaid.

What does Medicare Part C cover?

Medicare Part C plans are required by law to provide at least the same benefits and rights available with Original Medicare Parts A and B, except for hospice care. As private plans, Medicare Part C plans can offer advantages that federally administered Original Medicare won’t.

Additional services may include:

  • Yearly eye exams
  • Allowance for eyeglass lenses, frames, and contacts
  • Diabetic eye exams
  • Glaucoma screening
  • Dental checkups
  • Cleanings
  • Dentures and crowns
  • Hearing exams and aids
  • Gym memberships or discounts
  • Over-the-counter medications
  • Wellness services

Most Part C plans also include Part D Medicare Drug Coverage. Your Part C plan might provide bathroom safety aids and transportation to medical appointments as well.

What is not covered by Medicare Part C?

Medicare Part C will not pay for your deductibles or co-payments. You still need to pay monthly premiums for your plan and Part B, although some plans offer rebates toward the Part B premium.

Like Original Medicare, MA plans won’t pay for the medical expenses of your spouse or dependents. You would be responsible for paying for nonessential or unreasonable medical services, such as excessive procedures or for those with no diagnosis.

Medicare Part C normally does not cover hospice services or clinical trials. Original Medicare will help pay for these costs if you are in a Part C plan.

Costs included in Medicare Part C Plan

Your costs with Medicare Part C depend on the plan you join and how often you need health care services. Each Part C plan can charge out-of-pocket costs and set different guidelines for covering non-emergency care.

Amounts vary widely according to your plan, including what you’d pay for. However, some Part C plans have $0 premiums, and all have an out-of-pocket maximum of $8,300 in 2023.

You will have to pay for:

  • Monthly premium billed by plan provider
  • Deductibles
  • Coinsurance
  • Co-payments or co-pays

Who is eligible for Medicare Part C?

Anyone with Original Medicare (Part A and Part B) can enroll in a Medicare Part C plan. You must be at least 65 and a U.S. citizen or legal resident. Also, you must reside in the service area of the plan you wish to join.

Those younger than 65 with illnesses including amyotrophic lateral sclerosis (ALS) and end-stage renal disease (ESRD) can join a Part C plan. You’re also eligible for Medicare Part C if you’ve received monthly Social Security or Railroad Retirement Board (RRB) disability payments for 24 months.

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