Medicare Part C can cover many different things, from hospital stays to new eyeglasses. It’s bundled the coverage that Medicare Part A and Part B offer into one plan. However, under Medicare Part C, you’re typically required to use in-network hospitals and healthcare providers, including rehabilitation and specialist services.
Traditional Medicare Part A covers hospital stays, including broken bones, illnesses, or a stroke. The typical coverage includes the first 60 days that you’re in the hospital, although some services may be extra. Depending on the plan you choose for Medicare Part C, however, you may opt for higher premiums to ensure that you will have a private room, for example, should you need to be hospitalized.
If you need mobility assistance, skilled nursing, or physical therapy to recover from surgery or heal from an illness, broken bone, or other condition, Medicare will pay for your stay in a nursing home facility, as part of the Medicare Part A coverage. Nursing homes are different from other types of senior living and hospital care. These facilities typically have medical professionals on hand for rehabilitation therapy, and to help patients heal in a non-hospital setting. There are also care workers on hand to help patients move about, use the bathroom, and remain compliant with their medical directives.
Home health care often isn’t covered under traditional Medicare but can be covered under many Medicare Part C plans. Home health care involves visits by a healthcare professional for those that are homebound and unable to access medical care in a doctor’s office. You may need a physician’s certification that you need a certain level of care and that you are, in fact, homebound in order to be eligible for these services.
Visiting healthcare professionals can help with many different things, including diabetes management, physical or occupational therapy, dressing wounds, or hospice care. Patients will receive treatment according to their needs, although a doctor will have to re-certify the need for healthcare every 60 days.
Outpatient medical care is included with Medicare Part B coverage. This includes regular and specialist physician visits, although you’ll typically need a referral for a specialist if you’re covered under Medicare Part C. Outpatient care includes both medically necessary services and services intended to prevent disease. Coverage includes:
The patient’s financial responsibility for these services may be different than that of Medicare Part B patients. Additionally, you’ll have to choose a doctor that’s part of your coverage network.
Medicare Part C covers dental care, whereas, unless it’s an emergency, screening for an operation, or mouth disease, traditional Medicare does not. Medicare Part C dental plans include routine exams and cleanings as well as treatment for gum disease and fillings. Most plans don’t cover cosmetic dental procedures such as braces or veneers.
If you have poor vision, enrolling in a Medicare Advantage plan that covers eye exams and the cost of glasses or contacts may be an option for you.
Coverage typically includes routine hearing exams and the cost of hearing aids.
Some Medicare Advantage plans also cover fitness classes or gym memberships as part of disease prevention.
To enroll in a Medicare Advantage program, you must first be covered by Medicare Part A and Part B. You must be a U.S. citizen or permanent legal resident for at least five years to be eligible for Traditional Medicare. In addition to this, applicants must meet at least one other criteria:
Your financial responsibility for your Medicare Part B premium may vary according to your income level, as well as whether you sign up for Part B once you’re eligible. If you delay signing up, you may be assessed a fee. The standard premium for Part B is $144.60 as of 2020.
Medicare Part C is private insurance and offers alternative benefits to Traditional Medicare. In order to be eligible for Medicare Advantage plans, you have to live in the area that the plan covers and already be enrolled in Medicare Parts A and B. You’ll have to research the plans on your own and manually apply, although a licensed insurance agent or broker may be able to help you. You may also call 1-800-MEDICARE or go online for more information at www.medicare.gov.
Bear in mind that if you choose Medicare Part C coverage, you’re still responsible for paying for your Medicare Part B premium, as well as the Part C premiums.
Enrollment in Medicare Part C isn’t automatic, as it’s an optional program. Therefore, clients will need to enroll in Part C themselves. Medicare Part C plans differ by region, so it’s important that you review what each plan covers to make sure that you’re getting the benefits you need. You may do this in one of several ways:
The Initial Enrollment Period (IEP) for Medicare Part C is the same period as the Traditional Medicare IEP, the three months before the month you turn 65, the month of your birthday, and the three months afterward. However, if you’ve deferred your Part B enrollment, then your Part C IEP won’t begin until you’ve already enrolled in Part B. In these cases, you may be able to sign up for Medicare Advantage during either a Special Enrollment Period or the Part C General Enrollment Period.
The General Enrollment Period for Medicare Part C is referred to as the Open Enrollment Period (OEP) or the Annual Election Period (AEP). This is where beneficiaries can either enroll in Medicare or change their existing plans. Many times, people take advantage of this period for Medicare Advantage changes because their preferred physician may have moved to a different PPO or HMO coverage plan, or their needs may have changed, such as needing a vision or hearing care.
The AEP period is scheduled annually from October 15 to December 7. During this time, you may also add Part D coverage if you don’t have prescription drug coverage under your current plan, or change back to Traditional Medicare coverage.
The OEP occurs from January 1 to March 31 each year, with the same ability to end your Medicare Advantage Plan, change to traditional Medicare, change to a different Part C plan, or begin or end a Medicare Part D drug plan.
Medicare Part C is only offered to those who live within the plan’s coverage area. Therefore, if you move out of your plan’s coverage area, or into an area with different coverage plans, you’ll be able to change your Part C coverage.
Many people have questions about Medicare Part C. Here are some of the more common ones:
No. Once you’ve enrolled in Medicare Part A and B, you retain that coverage. However, the private insurance carrier that provides your Part C coverage will take over the administrative role of some of your benefits. You will not lose your Original Medicare, and if you choose to end your Part C coverage, you can easily revert back to traditional coverage during the Annual Enrollment Period October 15 through December 7.
No. Medicare Advantage is a different type of medical insurance than traditional Medicare. It’s not a replacement for this benefit, and it’s not a supplement. Part C plans are different in that a hospital, specialist, or doctor has to agree to the plan’s terms and conditions before they can treat the patient. The only exception is emergency care.
Medicare Advantage plans include a few primary care types, and most of these plans include prescription drug coverage.