Medicare Advantage - Medicare Part C
20 videos • 1,784 views • by Medicare on Video - HealthPlan65 The main parts of Medicare are broken down into lettered pieces. Medicare Part A is your hospital coverage, Medicare Part B is your outpatient coverage, and Medicare Part D is your prescription drug coverage. What about Medicare Part C? This part of Medicare is a bit different. When you enroll in Medicare you are given two options to supplement your coverage. You can either choose to stay with Original Medicare and enroll into a Medicare Supplement plan and a Part D Prescription Drug Plan, or you can choose a Medicare Part C plan, also known as a Medicare Advantage Plan. Medicare Advantage Medicare Advantage plans are alternative insurance that take you away from Original Medicare, and put you into a plan with a private insurance carrier. Essentially, these plans are a difference form of your Medicare coverage. It’s helpful to keep in mind that Medicare C isn’t for everyone and that it’s best to weigh your options to find out which one will fit perfectly for your healthcare needs. What are Medicare Advantage Plans? These are plans that will pay for your healthcare instead of Medicare. Consider looking at Medicare C as a combo deal of Parts A, B, and D all in one. With this part, you’ll have the ID card that you’ll use wherever you need healthcare. Many of these plans will have a Medicare Part D that is integrated within the plan. However, these may be absent in some areas, so make sure you look over those details as prescription drugs are expensive. These plans are typically structured as HMO, or sometimes PPO plans. Therefore, many of these plans offer benefits similar to what you’d find through your former employer’s health insurance plan. Usually, you’ll deal with a local network and will have copays for ordinary things like: Doctor’s visits Lab work Ambulance rides Surgeries Hospital stays Urgent care and other services Are Medicare Advantage plans free? Unfortunately, healthcare does have a cost to it. Medicare is often viewed as a pay-now or pay-as-you-go system. With a Medicare Advantage plan, you often have the benefit of lower monthly premiums. Some plans may even have $0 premiums! Sounds great, right? Don’t be fooled, these plans are not free plans. After enrolling in a plan, Medicare will pay a specific amount to the insurance provider with a fixed sum. Many companies will offer lower premiums in hopes you’ll sign up for the plan they offer. Remember, costs will change yearly. The expenses that change will be for your monthly premiums, any of your copays, the drug formulary, and any of the benefits you receive through the plan. Although the low to zero dollar premium sounds exciting, one aspect you really want to pay attention to on Medicare Advantage plans is the out-of-pocket maximum. With each plan, there is an out-of-pocket maximum (OOP) that the plan must have. This OOP is set by Medicare and is the highest amount allowable each year. For Part C, this amount is $6,700 in 2020, and $7550 in 2021. Remember that all your Part D spending does not contribute to this out-of-pocket maximum amount. The OOP is going to be the most you will spend in the year for your Part A and Part B charges. When it comes time to look at the different plans and parts of Medicare, take a look at Part C’s OOP maximum. Please consider whether or not you’ve had a bad year in your health, especially if there were lots of copays and coinsurance costs related to your health care. Check to see if you have enough saved up to meet this OOP maximum. If not, you may want to continue looking at other more cost-efficient options. Your Spending on Medicare Part C You will continue to pay your Part B monthly premium. You’ll also pay a monthly premium to your insurance company for your Part C plan. You may be responsible for a deductible. If so, this must be paid before the plan’s benefits kick in. Most medical services and treatment will require you to pay a copay or coinsurance. It is possible that many services will require coinsurance up to 20%. Your out-of-pocket maximum can be as high as $6,700 in 2020 or $7,550 in 2021. Keep in mind that some of these costs will vary from plan to plan and don’t include any Part D spending. It’s best to check your plan’s benefit summary to see your annual OOP and what expenses you’ll be required to pay.