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What You Need To Know About Medicare Part C

Medicare Part C is often referred to as a Medicare Advantage Plan. Every Medicare Plan features different benefits and pays for different services, whether you live in an independent living senior apartment, retirement community, assisted living or memory care facility or receive other senior care services.

Learn about Medicare Part C, the costs, what it covers and how you or your loved one enrolls to receive Medicare Part C benefits.

What Is Medicare Part C?

Medicare Part C or Medicare Advantage plans require that an individual enrolls in a Medicare Part C plan. Medicare Part C differs from traditional Medicare because you do not automatically receive Medicare Part C services and benefits when you enroll in traditional Medicare.

Medicare Advantage plans are plans offered through private Medicare-approved companies. You still receive your Medicare Part A and Part B benefits if you choose to enroll in a Medicare Advantage plan. The primary difference is that you receive these services through the private company and not Medicare.

While Medicare requires that each Medicare Part C plan provider follows rules set by Medicare, the Part C provider has some options in their plans, such as changing some costs and how you receive services under your Part C plan.

What Is The Cost Of Medicare Part C?

Your Medicare Part C costs potentially vary and depend on a number of factors. One important factor is that Part C companies may potentially charge a different amount for your out-of-pocket costs, compared to traditional Medicare costs.

Other factors that affect what you pay include whether the particular plan charges an annual deductible, a monthly premium, other types of deductibles and what it pays towards Medicare Part B premiums. Medicare Part B typically covers doctor visits, clinic visits, medical tests and other general medical services.

Other factors that determine your costs include the amount the plan requires you to pay for your co-pay for each visit to your primary care physician, specialist or other services under the plan. Your Medicare Part C co-pay amounts are not necessarily the same as those under traditional Medicare. The type of health care services you need and how often you need those services also potentially affect your out-of-pocket Part C costs as does whether you also have Medicaid or receive help from your particular state.

If you fail to follow the plan rules or see an out-of-network doctor or supplier, your Medicare Part C possibly adjusts your out-of-pocket expenses for your plan.

It is important to note that plan providers make any changes to your costs only in January of each year.

If you want to consider whether a Medicare Advantage Plan is the right choice for you or your loved one, contact each potential plan provider to determine your specific out-of-pocket costs. Residing in a senior living or senior care facility likely gives you the advantage of discussing your costs with the social worker or other designated case manager or employee of the assisted living, nursing home, skilled nursing facility or other senior care housing option of your choice.

What Does Medicare Part C Cover?

The Official U.S. Site for Medicare explains that insurers offering Medicare Advantage plans must cover all services offered by traditional Medicare benefits. You still receive emergency care and urgent care services. One likely advantage for many recipients of Part C is the fact that potential enrollees often discover that Medicare Advantage plans likely offer some benefits beyond those offered by traditional Medicare. For example, unless the result of catastrophic injury, traditional Medicare does not offer any vision or dental care services. Medicare Part C plans often features these services in their plan along with covering Part D, which is your prescription drug benefits, certain gym memberships or other healthy living benefits. This often fits into the active lifestyle of individuals residing in an active senior living community, their own senior apartment or other independent living community.

When choosing senior housing options, whether that option is skilled nursing, assisted living, nursing home, memory care, adult day care or home health services, Medicare Part C plans often covers at least some of the costs of senior health care. Remember that Medicare Part C providers must cover your hospital costs and everything that Medicare covers under Parts A and Part B coverage.

It is important that you do not assume that a plan in your area covers the same services or provides the same extra benefits that a friend or relative that lives in other area receives because different plans are offered in different states and different Part C providers feature benefits that vary from one provider to another. You have to check with individual plan providers.

How Do I Enroll In Medicare Part C?

Enrolling in Medicare Part C requires that you take an active role in the enrollment process. You or your loved one does not automatically receive Part C benefits upon enrolling in traditional Medicare.

You can only enroll in a Medicare Part C plan during specific enrollment periods, and can only change your plan during the enrollment period. There are some exceptions, such as if you move, begin receiving care at an institution, such as a skilled nursing facility, if you qualify for Medicaid or Medicare Extra Help.

You can sign up during your initial enrollment period which occurs once you turn 65 and are newly eligible for Medicare. In this case, enroll during the seven month period that ranges from three months before you turn 65 years old and three months after turning 65 years old. If you are under 65, qualify as disabled and became eligible for Medicare, enroll beginning 21 months after you start receiving Social Security or Railroad Retirement Board benefits.

The company that you choose for your Medicare Part C services has the enrollment, costs and coverage information you need. If you currently receive senior housing or senior care services or plan to in the future, ask the proper administration staff about services under Medicare Part C.

Written By

Jeff Hoyt

Editor in Chief

Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt

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