What Is Medicare Part C
Original Medicare is made up of Medicare Part A and Part B . Medicare Part C plans are all-in-one alternative healthcare options to Original Medicare and include the same benefits as Medicare Part A and Part B plus additional coverage.
When you enroll in a Medicare Part C plan, the company you enroll with becomes your primary source of health insurance.
Medicare Part C coverage must at least match Original Medicare coverage. However, since there are several Medicare Part C plan types, costs for enrollees can vary widely.
Who Is Eligible For The Part B Give Back Benefit
To be eligible for a give back plan, policyholders must meet specific criteria. First, you must be enrolled in Medicare Part A and Part B and pay your own premiums. This means that if your premiums are currently being covered by a state or local program, you will not qualify.
Additionally, you must live within the service area of a plan that offers a premium reduction plan. Currently, there are 48 states in the U.S. that offer this benefit.
Keep in mind, give back plans work directly with Social Security, so, no direct payments are sent to you by the carrier.
Services Medicare Doesnt Cover
- Most long-term care. Medicare only pays for medically necessary care provided in a nursing home.
- Custodial care, if its the only kind of care you need. Custodial care can include help with walking, getting in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine.
- More than 100 days of skilled nursing home care during a benefit period following a hospital stay. The Medicare Part A benefit period begins the first day you receive a Medicare-covered service and ends when you have been out of the hospital or a skilled nursing home for 60 days in a row.
- Homemaker services.
- Most dental care and dentures.
- Health care while traveling outside the United States, except under limited circumstances.
- Cosmetic surgery and routine foot care.
- Routine eye care, eyeglasses , and hearing aids.
Types Of Medicare Advantage Plans In Virginia
There are different types of Medicare Advantage plans in Virginia. Some types of plans may not be available in your area.
Health Maintenance Organization
With Medicare Advantage HMO plans, you get your care and services from doctors and hospitals in the planâs network. In most cases, prescription drugs are covered. Also common to these plans are specialist referrals. Coverage exceptions include:
- Out-of-area urgent care
- Temporary out-of-area dialysis
With Medicare Advantage HMO plans, you will be notified if your doctor leaves the plan. You will then be able to choose another doctor within the plan. If you receive health care outside the planâs network, you may have to pay the full cost.
Preferred Provider Organization
With Medicare Advantage PPO plans, there is a network of doctors, and hospitals. You may pay less if they these doctors and hospitals within the given network. Like Medicare Advantage HMO plans, you can also use outâofânetwork providers for covered services, but this may come at a higher cost.
Important things to know about PPO plans include:
Special Needs Plans
To be eligible to enroll in a Medicare Advantage SNP, you would need to meet the following:
- Live in a nursing home or community and require nursing care
- Eligible for both Medicare and Medicaid
- Have chronic and disabling conditions like diabetes End-Stage Renal Disease HIV/AIDS chronic heart failure dementia)
Private Fee-for-Service Plans
Other things to know about PFFS plans are:
How Medicare Advantage Works In Virginia
As of September 29, 2022, there were 1,594,003 people enrolled in Medicare in . As for Medicare Advantage:
- Medicare Advantage Plan premiums on average are $12.80 compared to $15.09 in 2022. A nearly 15% premium change!
- In 2023, there are 147 Medicare Advantage plans, compared to the 132 in 2022.
- All people eligible for Medicare will have access to a $0 monthly Medicare Advantage plan premium.
Medicare Advantage is designed to let beneficiaries get their Medicare Part A and Part B coverage through a private insurance company that contracts with Medicare.
Many Medicare Advantage plans offer other benefits as well, such as routing hearing care, vision care, wellness programs, and prescription drug benefits.
Medicare Advantage is legally required to provide the same amount of coverage as Original Medicare. These plans may also deliver extra benefits that you wouldnât get through Original Medicare, like dental, routine vision, and prescription drug coverage.
Please note that you still have to keep paying your Medicare Part B premium even when youâre enrolled in a Medicare Advantage plan.
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Is There A Medicare Part B Premium Giveback In My Area
In 2022, over 2,800 counties include at least one Medicare Advantage plan with a Part B premium Giveback or about 14,000 unique plan/county combinations of different Medicare Advantage plans 2022 Part B give-backs can range up to $148.50 or mor. https://q1medicare.com/q1group/MedicareAdvantagePartDQA/FAQ.php?faq=Do-any-Medicare
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How Do I Qualify For The Giveback
You may qualify for a premium reduction if you:
- Are enrolled in Part A and Part B
- Do not rely on government or other assistance for your Part B premium
- Live in the zip code service area of a plan that offers this program
- Enroll in an MA plan that provides a giveback benefit
Because not all plans offer this benefit, its important to do your research and compare plans, benefits, and costs to ensure youre making the best decision for you.
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Supplemental Benefits Are Not The Only Thing To Consider When Choosing A Medicare Advantage Plan
Medicare Advantage Plan supplemental benefits can be an important factor when choosing between plan providers as the benefits and degree of coverage offered by each plan will vary. Its important that you understand the pros and cons of the Medicare Advantage plan you are considering since you can only enroll and disenroll during the annual enrollment period.
That said, the extra benefits are not the only things to consider. When looking for Medicare Advantage Plans there are several things to keep in mind. First, make sure the plan offers coverage for the medications you use and contracts with your doctor, Jensen says.
You should also keep in mind that while the majority of Medicare Advantage Plans are HMOs, some plans are available as PPOs or HMO-POS, Jensen says. HMOs typically have a network of doctors and medical facilities that are covered under the plan. To get insurance coverage, you generally must use one of these in-network providers. With an HMO-POS, you have the option of paying more for an out-of-network provider.
PPOs give more flexibility in seeing specialists and out-of-network doctors, but they often have higher premiums than either HMO or HMO-POS plans. Jensen doesnt normally recommend PPOs because of their higher out-of-pocket costs.
If somebody wants to consider a PPO Medicare Advantage Plan, they should really be looking at Medicare Supplement plans as well, she says. A Medicare Supplement plan can offer flexibility and is worth a comparison.
What You Pay With Original Medicare
For Medicare parts A and B, you pay monthly premiums, and deductibles, copays, and coinsurance. You also pay the full cost of any services that Medicare doesnt cover.
- Premiums are amounts you pay to keep your Medicare coverage. Most people dont have to pay a Part A premium, but everyone must pay the Part B premium. The premium amounts may change each year in January.
- A deductible is the amount you must pay for medical expenses before Medicare begins to pay.
- A copayment is a set dollar amount you usually have to pay each time you see a doctor or go to the hospital.
- Coinsurance is the percentage of the cost of a service that you pay after Medicare pays its portion of the cost. This means that if Medicare pays for 80% of the cost of a service, youll pay the remaining 20%.
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Medicare Advantage Plan Quality By State
Every year, the Centers for Medicare & Medicaid Services rates all Medicare Advantage plans according to a five-star scale based on various quality metrics. Three stars represents a plan of average quality, while four stars is considered above average and five stars is excellent.
The metrics used in scoring a plan include:
Nationally, 55% of Medicare Advantage plans have earned either a 4-star or 5-star rating for 2022, meaning they are top-rated Medicare plans.
North and South Dakotas high plan costs can be partly justified by their high plan quality. Both states average at least 86% of plans carrying a 4-star or 5-star rating. Other states with high quality plans include Iowa, Minnesota, Maryland, Montana and Utah.
Plan quality is lowest in Wyoming, Georgia and Arkansas, with all three states having just a quarter of their Medicare Advantage plans rated 4 stars or higher.
Oasdi Beneficiaries By State And Zip Code 2021
This annual publication focuses on the Social Security beneficiary populationpeople receiving Old-Age, Survivors, and Disability Insurance benefitsat the ZIP Code level. It presents basic program data on the number and type of beneficiaries and the amount of benefits paid in each state, Social Security Administration field office, and ZIP Code. It also shows the number of men and women aged 65 or older receiving benefits. The data include only persons whose benefits are currently payable. Those whose benefits were withheld are excluded.
Cherice Jefferies in the Office of Statistical Analysis and Support programmed and compiled the data for this report. Staff of the Office of Dissemination edited the report and prepared it for web publication.
Natalie T. LuActing Associate Commissioner for Research, Evaluation, and Statistics November 2022
To avoid disclosing the reason for Social Security eligibility of small groups and the amounts of benefits received, a controlled rounding procedure was used for field office and ZIP Code data. Data are not shown for ZIP Codes with fewer than 15 beneficiaries.
Under the controlled rounding procedure, ZIP Code data on the number of beneficiaries shown in the table are changed according to the following formula:
The dollar amounts in the tables are rounded to the nearest thousand.
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Comparing Medicare Advantage Plans In Virginia
When looking to enroll in a Medicare Advantage plan, you might want to weigh plan costs against total benefits. Plans with lower monthly premiums sometimes charge higher deductibles, copayments, and coinsurance.
If youâre interested in a particular Medicare Advantage Prescription Drug plan, you may want to review the planâs formulary. It lists out all of the planâs covered prescription medications as well as your copayment for each costs can vary among plans. You might be able to find a plan that covers your prescriptions. The formulary may change at any time. You will receive notice from your plan when necessary.
Not every Medicare Advantage plan may be available in your county of Virginia. Just enter your zip code where indicated on this page to find out what plan options are offered in your area.
Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.
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What Differs By State
Medicare Advantage plans are offered by both local insurance companies and large national companies. No matter which company you go with, your plan will be specific to where you live.
Many plans are only available in a certain state, region, city, or even a single ZIP code. Even if the plan has the same name and covers the same services, your ZIP code could affect the price you pay.
Both Medicare Part D and Medigap plans work similarly. Like Medicare Advantage plans, theyre offered by private companies. You purchase them in addition to your original Medicare coverage, and the plans that are available to you will depend on where you live.
In general, plans in all states need to follow the same rules. For example, all Medicare Advantage plans must cover all the same services as original Medicare.
An exception to this is Medigap plans. In most states, Medigap plans will have the same letter names across all insurance companies and offer the same coverage. However, thats not the case in Minnesota, Wisconsin, and Massachusetts. All three of these states have their own Medigap regulations and plan types.
Defer Income To Avoid A Premium Surcharge
The standard premium for Medicare Part B is $170.10 per month in 2022 but that assumes youre not a higher earner. Those with higher income levels are subject to higher premium costs. For 2022 heres what youre looking at:
|2022 Medicare Part B premium costs by income level|
|Income level: individual tax filer||Income level: joint tax filer||Total monthly premium|
|$750,000 and above||$578.30|
If youre able to defer income strategically to future tax years so that you can report a lower total on your tax return, you might save yourself a higher premium charge for at least a year, since those surcharges are based on previous tax returns. For example, your 2020 tax return will determine whether you pay a surcharge in 2022 .
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Is There A Way To Get Free Medicare Coverage
If youâre a low-income person eligible for Medicare, you also may be eligible for Medicaid. Being eligible for both Medicare and Medicaid is called being âdual eligible.â In some cases, Medicaid might pay your Medicare Part B monthly premium. Medicaid may also offer additional benefits that traditional Medicare doesnât, such as prescription drug coverage.
Are you looking for a Medicare Advantage plan with a $0 premium? To see if one is available in your area, just enter your zip code on this page.
Social Security Benefits Are Not Impacted By Geographic Location But Other Federal Benefits Are We Took A Look At These Programs And How Benefits Vary
Social security benefits are calculated the same nationally. In each state workers making under a certain amount pay part of their salary in social security tax which they then receive as a part of their total benefit upon retirement.
However, some states do charge taxes on the benefits the rate and the exemptions available vary by the state. Survivor and railroad benefits are subject to the same rules as those paid to retirees.
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Are There Any Concerns With The Part B Give Back
Weve been helping our clients understand their Medicare choices for over two decades. One plan does not fit all. The mistake consumers sometimes make is enrolling in a plan based on cost only. The benefits and network availability must also be considered.
While its tempting to choose a plan with a large giveback benefit, it might be unsuitable if your doctors or hospitals are not in their network. And you should also make certain any Advantage plan covers your most important prescriptions. Especially if you take anything expensive or on a higher Tier.
Also, you want to be sure youre comfortable with Medicare Advantage plans in general. Some people prefer the flexibility of a Medicare Supplement. And switching back and forth between the two is not guaranteed. There are many variables to consider when choosing a supplemental policy.
The 10 Standard Medicare Supplement Insurance Plans
There are 10 Medicare supplement insurance plans. Each plan is labeled with a letter of the alphabet and has a different combination of benefits. Plan F has a high-deductible option. Plans K, L, M, and N have a different cost-sharing component.
Every company must offer Plan A. If they offer other plans, they must offer Plan C or Plan F.
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Who Can Join A Medicare Advantage Plan
Beneficiaries who have Medicare Part A and Part B can join a Medicare Advantage plan if they also:
- Live in the service area of the plan they want to join
- Are a U.S. citizen or legal resident who has lived here for at least 5 years
Not all Medicare Advantage plans are available in all areas. Most plans have a designated service area, or specific cities or zip codes, where they offer coverage. You must live within that service area in order to enroll in that plan.
If you live in another state for part of the year, or are curious about a plan’s service area, contact the plan directly.