Medicare Part C, commonly known as Medicare Advantage, is essentially Medicare parts A and B rolled into one, and in many cases may include part D. A medicare part c participant enjoys every benefit of original medicare plus a few added benefits. He or she does not lose anything by adding a part C to their Part A & Part B.
How Does Medicare Part C Work?
If you get Medicare Part C, you are actually getting a private health insurance plan that is available for people eligible for Medicare. These private insurance plans are Medicare-approved and cover part A and part B, and often part D, which covers prescription medications. Medicare pays these insurance providers a fixed amount for your care every month, though you may also have to pay for some costs out-of-pocket. Many of these insurance policies also have their own rules pertaining to how you get services, e.g., going to hospitals and doctors in their network. Both HMOs and PPOs are available under Medicare Part C.
Medicare Part C Costs
“Medicare Advantage plans can save you money, because out-of-pocket costs in these plans can be lower than with Original Medicare along. However, your cost will vary by the services you use and the type of plan you purchase.” Out-of-pocket costs can vary widely. The following factors can affect your out-of-pocket costs for part C, from Medicare.gov:
- Whether the plan charges a monthly premium.
- Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (copayment orcoinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
- The type of health care services you need and how often you get them.
- Whether you go to a doctor or supplier who accepts assignment (if you’re in a PPO, PFFS, or MSA plan and you go out-of-network).
- Whether you follow the plan’s rules, like using network providers.
- Whether you need extra benefits and if the plan charges for it.
- The plan’s yearly limit on your out-of-pocket costs for all medical services.
- Whether you have Medicaid or get help from your state.
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