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What Are Part C Medicare Benefits

Added Benefits And Services

Medicare Advantage Part C

Do you need extra coverage like dental, hearing, or vision care? Some plans include extra benefits for no extra cost. Some offer them as plan “riders” for an additional monthly fee. Look for a plan that meets your budget and helps you save money on the benefits and services you need.

How Much Does Medicare Part B Cost

Medicare consists of several different parts, including Part B. Medicare Part B is medical insurance and covers medically necessary outpatient care and some preventative care. Together with Medicare Part A , it makes up whats called original Medicare.

If youre enrolled in Part B, youll pay a monthly premium as well as other costs like deductibles and coinsurance. Continue reading to take a deeper dive into Part B, its costs, and more.

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Medicare Part B Premium Discounts And Regulations

You can save some money on your monthly costs by electing to have your Part B premium payments deducted directly from your Social Security checks.

Youll have to pay the standard premium if you are enrolling in Medicare Part B for the first time. Other reasons you might have to pay the standard Part B premium amount include:

  • You do not receive Social Security Benefits
  • Medicaid pays your monthly Part B coverage
  • You choose to be billed directly for your Part B premiums

In most cases, you will pay a late enrollment penalty if you do not sign up for Medicare Part B when you are first eligible. This penalty will be enforced for the rest of the time that you receive Part B coverage, and could increase by up to 10 percent for each 12-month period that you didnt enroll in Part B once you became eligible.

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Medicare Part C Medicare Advantage

A Medicare Advantage Plan is another plan choice you may have as part of Medicare. These plans, sometimes called Part C or MA Plans, are offered by private insurance companies approved by Medicare. The premiums are a flat rate, regardless of age.

If you join a Medicare Advantage Plan, it will provide:

  • Medicare Part A coverage
  • Medicare Part B coverage
  • Limits on the out-of-pocket costs you pay

Most include:

  • Medicare prescription drug coverage
  • Provider networks to help manage costs
  • Extra coverage, such as vision, hearing, dental, and/or health and wellness programs

In all types of Medicare Advantage Plans, youre always covered for:

  • Emergency and urgent care

Plans can charge different copays, coinsurance, and deductibles for these services.

Depending on the Medicare Advantage Plans offered in your area, you may have these options:

What Types Of Medicare Advantage Plans Are Available

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There are various kinds of Medicare Advantage plans, such as HMO, PPO, and Private Fee-for-Service plans. HMOs and PPOs each have certain characteristics, whether they are part of a Medicare plan or part of a regular health plan.

For example, an HMO plan typically comes with lower costs but requires you to see providers within a network and get referrals before you see a specialist. A PPO plan typically costs more, but offers more flexible options for seeing providers and may not require any referrals to see specialists.

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How Do I Sign Up For Medicare Part C

To join a Medicare Advantage plan, you must qualify for Original Medicare, which is available to people aged 65 and older, and younger disabled individuals. Medicare Advantage plans are available to U.S. citizens, U.S. nationals, and other people who are lawfully present in the United States. You must also live in the service area covered by the plan. You must be enrolled in Medicare Part A and B to join a Medicare Advantage plan.

For people who meet the eligibility requirements, its important to compare Medicare Advantage plans, since coverage and costs vary. Youll have to enter your ZIP code to find plans in your area. After choosing a plan, its necessary to fill out an enrollment form and pay the required premium to receive coverage under Medicare Part C.

LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.

Moore holds a bachelors degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.

Medicare Food And Grocery Allowance Benefits

Medicare Advantage plans add new benefits regularly, but the Medicare food allowance benefit goes above and beyond most available programs. Some plans pay $10 up to $120 monthly in healthy food grocery cards.

We discuss a few guidelines, eligibility requirements, and more below.

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Medicare Food Allowance Benefit

The grocery benefit provides beneficiaries with a quarterly allowance for qualifying food items. Eligibility is based on enrollment. Also, you need to live in the service area for one of these health plans to qualify.

The Part C food allowance benefit is sometimes combined with the over-the-counter allowance. Since every Part C plan is slightly different, comparing the health care coverage is essential. Its also wise to consider the wellness benefits, cost-sharing responsibility, and each plan formulary before you enroll.

You can expect Part C plans to offer great benefits. These plan extras come in many forms, such as a gym membership, dental, vision, or flex card.

What Is The Best Medicare Supplement

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As mentioned above, your best Medicare Supplement plan will be the plan that balances costs and coverage. In general, policies with more comprehensive coverage for deductibles and care will have higher monthly premiums.

For instance, Plan G is good for people who want very few medical bills and are willing to pay about $190 each month. This can give you peace of mind so that you wont be surprised by unexpected medical costs. However, if you expect your out-of-pocket medical costs to be less than the plans annual cost of about $2,280, then a cheaper Supplement plan may be more cost-effective.

Note that because of a recent legislation change, Plans C and F are not available for new enrollees. Below you can find a chart of the level of coverage and 2022 monthly premium ranges for all of the Medicare Supplement plans. The Medigap plan names are along the top, and on the left are the coverage categories.

Plan A

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How Much Will Medicare Cost Me Per Month In 2022

Do you know how much Medicare will cost you each month in 2022?

Planning for retirement is really important, and if youâre going to be living off of a fixed income, you need to be aware of your expected insurance costs.

So, how much will Medicare cost you in 2022?

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How Do You Choose A Medicare Advantage Plan

Its important to compare the benefits between your current coverage and the different types of Medicare Advantage plans . Be sure that you understand the additional benefits and any benefits that you may lose.

You may want to consider:

  • If you can change your current doctors
  • If your medications are covered under the plans formulary
  • The monthly premium
  • The cost of coverage. This could include annual deductible, copays, and coinsurance.
  • What additional services are offered
  • Any treatments you need that arent covered by the plan

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Who Is Eligible For Medicare Advantage Plans

There are 3 general eligibility requirements to qualify for Medicare Part C:

  • You must be enrolled in Original Medicare
  • There must be a Medicare Advantage plan offered in your area
  • You do not have End Stage Renal Disease
  • You enroll in a Medicare Advantage plan through a private insurance company, not the government.

    You must be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan.

    You cannot have a Medicare Advantage plan and a Medicare Supplement insurance policy at the same time.

    If your Medicare Advantage plan does not include prescription drug coverage, you may be allowed to add a Medicare Part D plan as well.

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    Other Facts To Know About Medicare Part C

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    Here is a list of other important facts you need to know about Medicare Part C plans:

  • Because youre still in the Medicare program, you have rights and protections.
  • At any time during the year, providers can leave a Part C Medicare plan, and plans can change network providers.
  • Part C plans are not allowed to charge more than Original Medicare does for certain services, such as skilled nursing facility care, dialysis, and chemotherapy.
  • You cant have prescription drug benefits through a Medicare Advantage plan and a stand-alone prescription drug plan at the same time. If youre enrolled in an MA plan with drug coverage and you enroll in a PDP, you will be disenrolled from your MA plan and reenrolled in Original Medicare.
  • You cant have Medicare Advantage and Medicare Supplement insurance If you want to join a Medicare Supplement plan, also called Medigap, you would need to make sure you can leave your MA plan before your Medigap coverage begins.
  • If youre enrolled in a Medicare MSA, an insurance company cant legally sell you a Medigap policy.
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    Covered By Medicare Part A And Part B: Home Health Care

    Some limited home health care is covered under Medicare in certain circumstances and this benefit may be covered under Medicare Part A and/or Part B. These Medicare benefits, which a home health care agency typically coordinates, may include:

    • Intermittent or part-time skilled nursing care or home health aide.

    • Physical and occupational therapy.

    • Injectable osteoporosis drugs.

    Changes To Medicare Advantage Under Obamacare

    In 2014, the Affordable Care Act changed the healthcare system in America and also changed small parts of Medicare. The only real change that most people noticed is that now Medicare and Medicare Advantage plans must include preventive care and cannot reject anyone for pre-existing conditions.

    There was also an initial drop in the number of Medicare Advantage plans being offered. An Avalere Health analysis found a 5 percent drop in the availability of Medicare Advantage plans. In addition, the variety of plan types also dropped, with more Medicare Advantage providers offering only HMO policies instead of PPO, PFFS and Special Needs Plans.

    For the 2020 enrollment season, Medicare Advantage customers saw an increase in plan options nationwide, with a total of over 5,000 Advantage plans on the market according to state data that we analyzed from the Centers for Medicare and Medicaid Services.

    The donut hole, which is a coverage gap in Medicare, has also been eliminated thanks to measures put into place under the Affordable Care Act. Now, once you reach your drug plans initial coverage limit , youll pay 25 percent of the cost of your medications until you reach the catastrophic limit on the other side.

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    Should I Enroll In Medigap

    If you are enrolled in Medicare Part C, you do not need a Medigap plan .

    If you have Original Medicare plus a Medigap plan and want to switch to Medicare Advantage, you’re allowed to keep the Medigap plan. But you will not be able to use it while you have Medicare Advantage, and you would have to continue paying monthly premiums to maintain the Medigap plan.

    Keeping it would only be useful if you were to decide later that you wanted to return to Original Medicare and had health conditions that would make you ineligible to re-enroll in a Medigap plan.

    Note that you have a one-year trial right period in such situations. You can drop your Medicare Advantage plan, return to Original Medicare, and re-enroll in the Medigap plan without medical underwriting . It’s unnecessary to keep your Medigap plan “just-in-case” while you test out a Medicare Advantage plan for less than a year.

    You’ll want to keep the long-term picture in mind when enrolling in Medicare. Although there’s an annual open enrollment period each fall when you can switch your Medicare Part C and D coverage, there is no similar ongoing enrollment opportunity for Medigap plans.

    In most states, you only have one six-month window , during which you can enroll in Medigap without medical underwriting.

    These are important factors to keep in mind when you’re enrolling in Medicare you want something that fits your budget and lifestyle but will also keep up with your needs in later years.

    Costs For Medicare Advantage Plans

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    What you pay in a Medicare Advantage Plan depends on several factors. In most cases, youll need to use health care providers who participate in the plans network. Some plans wont cover services from providers outside the plans network and service area.

    Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for all Part A and Part B services. Once you reach this limit, youll pay nothing for services Part A and Part B cover.

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    What Is A Special Election Period

    A special election period or special enrollment period is when someone can change their Medicare Advantage coverage outside of the official AEP or IEP.

    When certain qualifying events happen, such as moving to a new area or losing existing insurance coverage, this triggers an SEP.

    There are various rules and approved reasons that affect what changes an individual can make to their Medicare coverage.

    The government has a calculator that people can use to determine whether they are eligible for Medicare coverage and, if so, the likely premium.

    People can use the calculator at Medicare.gov.

    What Happens If I Don’t Have Medicare Part D

    If you don’t sign up for a Part D plan when you are first eligible to do so, and you decide later you want to sign up, you will be required to pay a late enrollment penalty equal to 1% of the national average premium amount for every month you didn’t have coverage as good as the standard Part D benefit.

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    Medicare Part D Donut Hole Coverage Gap Costs

    Medicare Part D prescription drug plans and some Medicare Advantage plans have what is known as a donut hole or coverage gap, which is a temporary limit on how much a Prescription Drug Plan will pay for prescription drug costs.

    As of 2020, Part D beneficiaries pay 25 percent of the cost of brand name and generic drugs during the coverage gap until reaching catastrophic coverage spending limit.

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    What Is The Difference Between Part C And Part D Medicare

    Medicare Part C

    Medicare Part C is an alternative to original Medicare. It must offer the same basic benefits as original Medicare, but some plans also offer additional benefits, such as vision and dental care. Medicare Part D, on the other hand, is a plan that people can enroll in to receive prescription drug coverage.

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    Whats The Difference Between Original Medicare And Medicare Advantage

    The main difference between Original Medicare and Medicare Advantage is that Original Medicare benefits are administered by the government, and Medicare Advantage benefits are administered by private insurance companies.

    Medicare Part A is known as hospital insurance. It covers services that are considered medically necessary to treat a disease or condition you may have.

    In general, Part A can cover:

    • Skilled nursing facility care
    • Inpatient care in a hospital
    • Nursing home care
    • Home health services including : physical therapy, occupational therapy, and speech-language pathology services

    Medicare Part B is known as medical insurance. It covers medically necessary services needed to diagnose and treat a medical condition, as well as services to prevent or detect common illnesses at an early stage.

    Part B can cover:

    • Outpatient medical services
    • Ambulance services, including emergency ground transportation to a critical access hospital or skilled nursing facility when you cant be safely transported by car or taxi
    • Durable medical equipment , including canes, oxygen equipment, and blood sugar monitors
    • Mental health services, including inpatient, outpatient, and partial hospitalization
    • Second opinions before non-emergency surgery to know and understand your treatment options
    • Limited outpatient prescription drugs under limited conditions
    • Clinical research

    Medicare Part C Vs Other Plans

    Medicare Part C plans and traditional Medicare policies are different. Part C bundles services together, and depending on the plan, may offer more services than traditional Medicare, including dental, vision, and hearing care.

    People should check theirindividual plan to see what it covers on top of traditional Medicare. Companiesoffer many different plans.

    • If a person uses traditional Medicare, they pay Medicare directly, and Medicare pays out for their services.
    • Medicare Part B: A person pays their Medicare Part B premium directly to the government.
    • Medicare Part C: People with Part C pay a private insurance company.
    • Medicare Part D: Medicare Part D is the traditional portion of Medicare that pays for prescription drug coverage. A person can select from several plans and pay a monthly premium directly to the government.
    • Medigap: Medigap insurance can help a person pay for co-payments and deductibles, as well as other out-of-pocket expenses.

    Some people prefer thefreedom of choosing their own providers and specialists that can come withtraditional Medicare.

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