What is Medicare Part C & What Does it Cover?
Medicare Part C is an additional insurance option for persons who are eligible for Medicare. These insurance plans are administered by private insurance firms that are Medicare-approved. These firms must adhere to specific federal and state requirements. The Medicare part C plan benefits are the same as those of (Medicare part A) hospital services and (Medicare part B) outpatient services but with an added benefit. Some of these benefits include prescription medication and dental health care.
Medicare Part C is divided into various forms, similar to non-Medicare health insurance, each with its own set of restrictions for identifying care providers. For instance, in a health maintenance organization (HMO) plan, you must see in-network doctors unless you have an emergency and get a referral to see a specialist. In a PPO (Preferred Provider Organization) plan, you can see both in-network and out-of-network doctors, though going out of network usually costs more. You must understand which parts of the plan you’re supposed to pay for and what is covered by the Part C plan.
What does Medicare Part C cover for inpatient services?
Under original Medicare, inpatient services are usually insured by Medicare Part A. Part C will provide inpatient coverage that is at least equivalent to Medicare Part A. Services offered to include:
• Skilled Nursing Facility Care
• Hospital Inpatient care
• Mental health Inpatient services
• Rehabilitation Inpatient services
• Hospice care
• Limited home healthcare
What does Medicare Part C cover for Outpatient services?
Again, your Part C plan must cover at least what Medicare Part B would cover, which includes:
• Scheduled doctor’s appointments, including specialists
• Emergency transportation by the ambulance
• Acquiring medical equipment such as wheelchairs or home oxygen equipment
• Emergency room care
• Any Laboratory testing, like blood tests or urinalysis
• Tomography tests, such as MRIs and X-rays
• Mental health counseling
• Vaccinations for flu, hepatitis B, and pneumococcal disease
Does Medicare Part C Cover Prescription Drugs?
The Medicare Advantage package incorporates Medicare part D, which is a coverage on prescription drugs. Restrictions applied in the drug prescription coverage with Medicare Advantage plans are pretty strict. Suppose you get a Medicare part C that offers its prescription drug plan while still enrolled in Original Medicare or try to purchase a separate prescription drug plan. In that case, you will be disenrolled automatically from the Medicare Part C Cover and returned to Original Medicare. To prevent this, choose a Part C plan without prescription drug coverage over a Part D plan with drug coverage. However, people have been accorded purchase right to a separate Medicare Advantage Plan if the Medicare Part C Cover: It cannot offer prescription drug coverage like a PFSP (Private Fee-for-Service Plan). You must consult your doctor to determine what prescription drug plan works best for you.
What Are the Additional Benefits of Medicare Part C Insurance?
A Medicare Part C plan lets you customize your Medicare plan by adding benefits and coverage that aren’t available under the original Medicare. Original Medicare, for example, may cover things like doctor visits and hospital stays, but it does not cover vision or dental treatment. On the other hand, a Medicare Advantage plan may include all of the coverage provided by Original Medicare and additional benefits. These benefits include:
• Eyes examination, including glasses
• Ear inspection, including hearing aids
• A dental check-up, including dentures and teeth cleaning
• Fitness programs
• Daycare services for adults
• Over the counter drugs
• Transportation to Doctor’s appointments and other services that promote health and wellness
What should you do if your Medicare Part C plan fails to cover something you need?
If you are denied coverage for something you require, you should first take the initiative to file an appeal. In this case, you can file an appeal for a healthcare service or prescription medication that you believe you should be able to obtain or have already received. You can also file an appeal to pay a lower amount than what was initially requested. Suppose your appeal is denied, or you’re unhappy with your current plan. In that case, you can transfer your Medicare Advantage plans during the annual registration period, which runs from October 15 to December 7.
Eligibility for Medicare Part C
You will qualify for the Medicare Part C plan if you have both Plan A and B. Similarly, you will be eligible for Part C if you reside in the plan’s service region. Additionally, patients with end-stage renal disease (ESRD) can now take advantage of the range of services that come with the plan, according to a bill passed by Congress that took effect in 2021. Most providers decline to take in patients who had had an ESRD diagnosis before the regulation became effective. Instead, such patients are restricted to a Special Needs Plan (SNP).
How much do Medicare Advantage plans cost?
The cost of Medicare Advantage plans depends on several factors like:
• The part B Monthly charges, which the Part C plan can cover
• Your Medicare Advantage plans which include deductibles and monthly premiums
• Costs you pay out of your cash which includes copayments and coinsurance
Joining Medicare plan
If you’re registering for Medicare for the first time, you can choose the Medicare Part C plan during the Initial Enrollment Period or you can visit ClearMatchMedicare to learn more about Medicare. If you have already signed up in Medicare, you can swap to the Part C plan as per the existing regulations.