Understanding the Costs of Medicare Part C
Reviewed by: Ed McClane, Licensed Insurance Agent
Some Medicare Advantage plans have a $0 Part C premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. and cover up to 100% of the Part B premium too!
Medicare Advantage plans include Part A and B and most offer Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. coverage. Many offer extra benefits like vision, dental and wellness.
If your providers are in-networkIn-network refers to the doctors, hospitals and other providers that are inside of your provider network. A provider network is a group of providers that have agreed with your health insurance company to treat its customers., you can save on the cost of health services and get additional benefits compared to Original Medicare.
If you’re new to Medicare, you must enroll in Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). before selecting a Medicare Advantage plan.
With so many different Medicare plans to choose from, it can be challenging to compare costs and know what you will be required to pay. We want to partner with you to find the right coverage to fit your lifestyle and budget.
Find a local Medicare plan that fits your needs
The cost of Medicare Advantage (Part C) coverage depends on your plan type and where you live. Medicare Advantage plans may have a lower out-of-pocket costs for certain services than Original Medicare (Part A and Part B). They also have an out-of-pocket maximum. Once you have reached the plan’s limit for Medicare Part A and Part B services, you’ll pay nothing for services Part A and Part B covers for the remainder of the plan year. [i]
Most Medicare Advantage plans include Part D and dental, vision, and hearing. Unlike Original Medicare, which requires members to purchase Part D or Medicare Supplement plans separately.
Additional cost considerations
When it comes to Medicare, you need to consider general healthcare costs to get the full picture of your annual costs. Here are a few basic items to consider when getting started with Medicare:
- Medicare Advantage plans vary and so do the costs. The type of plan you choose can affect your annual costs.
- Your monthly premiums are what you pay to have active health insurance. Most Medicare Advantage plans have a monthly premium but some offer a $0 premium.
- Medicaid or financial assistance from your state government
- Annual deductible, copayment, coinsurance and out-of-pocket maximum amounts for all services
- Is your current provider in-network with the plan you want? You can contact a GoHealth licensed insurance agent to find out.
- Consider your care plan and visit frequency
- Associated costs for additional needed benefits
- You may pay the plan’s premium in addition to the Part B monthly premium.
- You pay copayments per visit.
Medicare Advantage (Part C)
- You may pay the plan’s premium in addition to the Part B monthly premium. Although, some plans help pay up to 100% of the Part B premium. And, some plans have a $0 Part C premium.
- Some plans have a $0 copay.
- You have the plan’s out-of-pocket maximum. Your plan pays 100% of your costs after you reach the limit.
Original Medicare does not have an out-of-pocket maximum. Members will pay 20% of the cost of services unless they choose to add coverage like Part D or Medigap. Medicare Supplement plans (Medigap) can be added to Original Medicare to cover costs like deductibles, copays and coinsurance.
Are you eligible for cost-saving Medicare subsidies?
Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A & B benefits or coverages as Original Medicare. Along with receiving Part A & B benefits, Medicare Part C often bundles your benefits with additional ones like dental, hearing, vision, and prescription drug coverage.
When you have Medicare Part C, your Part C benefits ID card replaces your Medicare ‘Red, White & Blue’ card at every visit.
Your costs with a Medicare Advantage plan can vary based on things like how often you visit your doctor, if your primary doctor is in-network or out-of-network, and your prescription drug needs. When it’s time to compare your options, consider these tips:
- Part C does have a provider network. [i] You can contact a GoHealth licensed insurance agent or the plan to find out if your doctor is in-network. Receiving care out-of-network may not be covered thus increasing your cost considerably.
- Deductibles and copays can add up if you anticipate frequent doctor visits or the need for specialty care. It may be helpful to compare your Medicare Advantage plan costs alongside Original Medicare and Medicare Supplement coverage.
- Prescription drugs (Part D) are usually covered with a Medicare Advantage Plan. Original Medicare requires members to add Part D coverage, which has its own monthly premium. Either way, you should make sure your prescriptions are covered by any Part D plan you choose.
If you’re looking for quick plan comparisons and straightforward answers to your Medicare questions, GoHealth can help. A GoHealth licensed insurance agent can compare all the plans available to you side-by-side and find the plan that meets your needs.
What extra benefits and savings do you qualify for?
If covering the cost of Medicare is a challenge, there are options. Medicare Savings Programs (MSP), like Medicaid, is offered by your state. This program can help you pay for premiums, deductibles, coinsurance and copays. You must qualify, based on low-income, for MSP and programs like Extra Help, which covers some or all of your prescription drug costs.
We understand it can be challenging to figure out exactly what coverage you need. Take time to compare what different plans offer and whether those services match your needs. If you have questions, connect with a licensed GoHealth agent who can answer your questions.
Medicare does not allow people to have both Medicare Supplemental (Medigap) and a Medicare Advantage Plan. Medicare Advantage Plans offer many of the same benefits as Medigap. Contact your insurance provider to cancel the policy if you enroll in Medicare Advantage.
You will get Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) notices each year when you’re enrolled in a Medicare Advantage Plan.
The annual notice is an explanation of expected changes for the next year, including coverage and costs. You should receive this information by September 30. Evidence of Coverage explains your plan and how much you pay. You should receive this notice by October 15.