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Part C

Submitted by igdmaster on Tue, 05/30/2023 - 10:36

Part C refers to plans offered by private insurance companies which cover the benefits offered by Original Medicare (Parts A & B).  Some private insurance plans also include Part D prescription drug coverage.  The most common kind of Part C plan is known as a Medicare Advantage plan.  Besides covering Medicare services, Medicare Advantage plans may offer additional benefits, such as dental and vision coverage, hearing aid subsidies, gym memberships, over-the counter allowances, home care services and reimbursements for travel to medical appointments.

You must continue to pay your Part B premium while enrolled in a Medicare Advantage plan.  Most Advantage plans impose an additional monthly premium. 

Besides the monthly premiums, you are responsible to pay deductibles, copays or coinsurance for the medical services you receive through a Medicare Advantage plan.  The Medicare Advantage plan changes how you share the costs of your services, but in a manner that is considered equivalent to your cost-sharing under Original Medicare.  For example, instead of paying a $1632 Part A deductible for one night in the hospital, you may be charged a one-day copay of $325.

One of the benefits of a Medicare Advantage plan is the protection offered by an annual out-of-pocket maximum (OOPM).  Your responsibility for cost-sharing under Original Medicare is unlimited—there is no cap on the amount you may have to pay for deductibles and coinsurance.  With a Medicare Advantage plan, however, your responsibility for deductibles, copays and coinsurance ends when you reach the OOPM.  Deductibles and copays for prescription drugs are not included in the OOPM.

Medicare Advantage plans limit services by networks. To receive the maximum benefit from your plan, you must use doctors and hospitals in the plan’s network.  There may be no coverage from the plan if you receive a service outside the network.