It all seems like a big bowl of alphabet soup! Part A, B, C, D…what’s the difference and what does it all mean?
In my previous post I explained Medicare Part A and Part B. I tried to lay the foundation for the first two choices in your Medicaid journey. In it, I stated it’s best to simply eat this Medicare elephant one bite at a time in order to not feel overwhelmed.
In doing so, lets take a bite out of Part C to see what it’s all about.
Top 12 basics of Medicare Part C:
- Medicare Part C is another name for Medicare Advantage
- Medicare Advantage plans are offered by PRIVATE INSURANCE COMPANIES not the federal government.
- You have to enroll (add link https://www.medicare.gov/sign-up-change-plans/getting-started-with-medicare ) in traditional Medicare Part A and B in order to be eligible to join a Part C plan.
- You’ll still be in the Medicare program, but you’ll receive your benefits through the INSURANCE PLAN instead of Original Medicare.
- Part C covers everything that Original Medicare (Part A&B) cover and may cover extra benefits as well
- Part C plans are OPTIONAL, so not everyone needs Part C
- Examples of Part C plans are Humana Gold Plus, Aetna Advantage Plus and Anthem MediBlue Access.
- Part C includes all the benefits of Part A including hospital stays, skilled nursing, home health and associated services
- It also includes all the benefits of Part B including doctor visits, outpatient care, screening and lab tests
- Prescription drug coverage IS included in most Part C plans
- There are additional benefits such as dental, eye care, hearing care and wellness services
- Part C plans all have a yearly LIMIT on your out of pocket costs
Think of Medicare Advantage plans as a package where you will have Part A, Part B and usually Part D together in one plan. You will have one ID card that you use at hospital, doctor’s office and pharmacy.
Medicare C plans resemble group insurance benefits you may have had through former employers. Generally, there is a local network of providers that you will use. You will pay copays for many routine services like doctor’s visits, lab-work, ambulance, surgeries, hospital stays, urgent care and more.
How Much Does Part C Cost?
Medicare Advantage enrollees pay the premium for Part B ($135.50/month in 2019 for most enrollees), plus the premium for their Medicare Advantage plan.
As of 2019, the average Medicare Advantage premium was $34/month, but that included the 51 percent of Medicare Advantage enrollees who had zero-premium plans (ie, they only had to pay their Medicare Part B premiums, as their Advantage plan didn’t have a premium).
Among the 49 percent of Advantage enrollees who did have a monthly premium for their Advantage plan (in addition to their monthly premium for Medicare Part B), the average premium was $70/month in 2018.
People with Part C coverage typically incur only a small copayment when visiting a doctor or other provider, while those with Original Medicare pay 20 percent or more of the cost of services. Some Medicare Advantage plans may drop services or raise premiums and copayments from year to year.
How Do You Know If A Medicare Advantage Plan is Right For You?
Selena Maranjian is a writer for The Motley Fool. She wrote an article in 2016 titled “Should You Get A Medicare Advantage Plan?” Her article contained the following advice:
Why sign up for Medicare Advantage?
Here are some reasons to favor Medicare Advantage plans:
- Many Medicare Advantage plans, unlike original Medicare, cover hearing, vision and/or dental care. Medicare Advantage plans also typically include prescription drug coverage, while those with original Medicare have to sign up for — and pay for — Part D coverage.
- A Medicare Advantage plan can cost you less. Original Medicare will often have you footing 20% of many bills with no limit on how much you might have to pay out of pocket. (Paying only 20% can seem OK until you get a bill for $50,000 and suddenly have to cough up $10,000.) A Medicare Advantage plan might charged you a certain copay per doctor visit or service, and many services will simply be paid for through your premium. Medicare Advantage plans also feature out-of-pocket spending caps. (The average out-of-pocket cap was recently $5,223,but many plans feature caps below $3,000 and the limit for 2017 is $6,700.) Once you hit the limit, the plan will pay all further costs. Better still, many plans charge the enrollee nothing in premiums. (The Medicare program pays the insurance company offering it a set sum per enrollee and if the insurer thinks it can make a profit without charging its customers anything, it can do so.) The average monthly premium for Medicare Advantage plans was recently $33.
- While original Medicare can’t be used outside U.S. borders, some Medicare Advantage plans offer coverage abroad.
Medicare Advantage plans are probably sounding pretty good right now. They’re not perfect, though.
Why you might not want a Medicare Advantage plan
Here are some downsides:
- It can be hard to compare Medicare Advantage plans, because of their different costs and fee structures and the different kinds of coverage they offer. Here’s a tip, though: The Medicare system rates Medicare Advantage plans (and Part D plans), so look for ones with higher star ratings, as they will likely serve you best. (The top score is five stars.) Medicare Advantage plans earn their stars by being evaluated on measures such as how well they’re keeping their members healthy (via screenings, checkups, and more), how well they’re managing members’ chronic conditions, and how good their customer service is. You’ll find the star ratings of plans available to you by using the Medicare Plan Finder at the Medicare website. (Another nifty thing about five-star plans is that they don’t limit you to the usual enrollment period. If you’re switching into a five-star plan, you can do so throughout mostof the year, from December 8 through November 30.)
- A Medicare Advantage plan won’t necessarily cost you less than original Medicare would. You need to take a close look at any plan you’re considering and compare it with original Medicare, keeping your health profile and likely healthcare needs in mind. (For example, if most of your healthcare costs are related to prescription drugs, see which plan offers the best deal related to the drugs you take.)
- While original Medicare lets you see any healthcare provider in the country who accepts Medicare, Medicare Advantage plans, often operating as HMOs or PPOs, will typically limit you to a network of doctors — though these networks are sometimes very big. But even with a big network, if you travel frequently, you may find yourself far from service providers in your network.
- Medicare Advantage plans may require you to follow certain rules regarding getting care, such as getting a referral to see a specialist from your primary care physician.
- If you have a Medicare Advantage plan that you like, it may not be around next year. The insurance companies offering Medicare Advantage plans have contracts with Medicare that are not always renewed from year to year. Even when renewed, some terms of the plan may change, such as which drugs are covered.
- Some members have reported that getting emergency or urgent care is more difficult with a Medicare Advantage plan than with original Medicare. It can be worth looking into how emergency care will work in any plan you’re considering.
How and When Can You Enroll?
When it comes to choosing the best health insurance plan in retirement, there’s no one-size-fits-all solution. Look into all your options and see which makes the most sense for you. Do the math, comparing premiums, copays, deductibles, and so on — to see which plan is likely to cost you the least and/or offer more coverage.