Medicare Part C, also known as Medicare Advantage, is a health insurance plan offered by private insurance companies that have been approved by Medicare. Advantage plans give you the option to enroll in a single policy that contains the same coverage as Medicare Parts A and B, as well as prescription drug coverage.
With so many parts and plan options, Medicare can be confusing. We’ll explain everything you need to know about Medicare Advantage plans, and whether they’re right for you.
How Is Medicare Part C Different from the Other Parts of Medicare?
A major difference between Medicare Advantage (Part C) plans and Original Medicare plans is the insurance providers. While the U.S. government provides the coverage on Original Medicare plans, Medicare Advantage plans are offered by private insurers who are vetted by the government.
Medicare Advantage plans and Original Medicare also differ in coverage. Original Medicare consists of Part A, B, and D. Part A covers inpatient services like hospitalization or care in a skilled nursing facility. Part B covers outpatient care such as routine doctor visits, lab tests, and preventative care. Part D provides coverage for prescription drugs.
Medicare Advantage plans provide the same coverage as Part A and Part B, as well as prescription drug coverage that varies with each plan. Since private insurers offer Medicare Advantage plans, drug formularies vary.
Find discounts on drugs not covered by your Medicare Part C plan:
Some Part C plans can also provide additional vision and dental benefits that may not be covered by Original Medicare. They may even give you extra wellness benefits like discounted gym memberships.
Is Medicare Advantage Right for Me?
Individual needs vary, so it’s important to compare your health insurance options and choose the coverage that is right for you. Here are some of the benefits of Medicare Advantage plans:
- Same coverage as Medicare Part A and Part B.
- Added benefits such as prescription drug coverage, dental, and vision (varies by plan).
- Care coordination; under certain Part C plans, you can designate a Primary Care Physician (PCP) to help coordinate your care. Certain plans also provide medication therapy management.
Overall, a Part C plan offers more comprehensive coverage in one plan. If you were to enroll in an Original Medicare plan, you would have to elect for Part D prescription drug coverage separately, and dental and vision care would be limited.
However, there are a few drawbacks to Medicare Advantage plans, including:
- More limited provider networks
- Special authorization or referral requirements
While Original Medicare plans allow you to see any provider who accepts Medicare, a Part C plan requires you to see a provider in that plan’s specific network. The Part C provider networks are usually regional, not national like Original Medicare. Additionally, your Part C plan may require you to obtain prior authorization for certain medical procedures or get a referral from your PCP to see a specialist.
Medicare Supplement Insurance
You may have heard about Medicare Supplement Insurance, or Medigap. Like Medicare Advantage plans, Medigap is offered by private health insurance providers.
However, Medigap requires you to maintain Medicare Part A and Part B coverage. In fact, it is illegal for you to purchase Medicare Supplement Insurance if you have an Advantage Plan. If you currently have Medigap and are thinking of joining an Advantage Plan, you should contact your insurance company to drop your policy.
A Medigap policy is meant to help cover additional healthcare costs that Original Medicare does not, like:
- Deductibles
- Coinsurance
- Copayments
As a supplement to Original Medicare, you must pay a separate monthly premium for your Medigap policy. This payment is made to the private insurer issuing the policy.
It is important to note, Medigap policies are supplemental and only offer limited coverage. For example, policies may not cover:
- Prescription drugs
- Vision or dental care
- Most long-term care
- Private-duty nursing
In this regard, Medicare Advantage plans offer the benefit of an all-in-one comprehensive policy.
Can I Be Turned Down For A Medicare Advantage Plan?
In general, if you are eligible for Medicare Parts A & B, then you will not be denied coverage by Part C. Patients with pre-existing medical conditions are also still eligible for Medicare Advantage plans. The only exception is for End-Stage Renal Disease (ESRD).
Individuals with ESRD may be ineligible for most Medicare Advantage plans. However, certain Special Needs plans may still provide coverage.
Medicare Advantage Plan Costs
Monthly premiums for Medicare Advantage plans can range from $0 to more than $300. Premiums vary between plans and even by location. However, when comparing plans, it’s important to consider more than just premiums.
For example, while some plans may have a $0 premium, copays and deductibles for these plans can be much higher than in plans with more expensive premiums. Always compare all the costs of a plan and make sure that it meets your healthcare needs.
Medicare Advantage Plan Prescription Drug Coverage
While many Medicare Advantage plans include prescription drug coverage, drug formularies vary across plans. This means co-pays may differ and not all drugs will be covered by your plan.
If your medication is not covered by your Medicare Part C policy, or the co-pay is too high, ScriptSave WellRx may be able to help you save. Our drug price comparison tool lets you check prices at multiple pharmacies in your area. You can also get a free prescription discount card to help you save at the pharmacy.
References:
Store & manage your medication list
Medication pricing updates
Import medication from your pharmacy
Pill & refill reminders
Medication journal & mood log