Understanding the Costs of Medicare Part C
How much does Medicare Advantage (Part C) cost?
Medicare Advantage plans have a monthly premiumA premium is a fee you pay to your insurance company for a health plan coverage. This is usually a monthly cost., though some plans’ premiums are $0.
Medicare Advantage plans include Part A and B and most offer Part DMedicare Prescription Drug Plan (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. This is the group of providers that has 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 (Parts A and B) is fee-for-service health insurance available to all 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.
The cost of Medicare Advantage (Part C) coverage depends on your plan type and where you live. Out-of-pocket costs for medical services are generally lower than the costs of Original Medicare (Part A and Part B), and there’s usually a yearly limit. You won’t pay anything for covered medical services after you reach your out-of-pocket maximum.Out-of-Pocket Maximum (OOP) is the maximum amount of money an individual will pay towards out of pocket expenses like deductibles, co-payments, and co-insurance.
Medicare Advantage covers many of the gaps in Original Medicare. It also provides similar benefits as having both Original Medicare and Supplemental Coverage plans, but for a lower price. With Part C, however, you can’t buy or use separate Supplemental Coverage plans.
Let’s take a look at other cost information to consider:
- Plan type
- Monthly premiums (some Medicare Advantage Plans do not have premiums)
- MedicaidMedicaid is a state-based health insurance program based on an individual's financial needs. or financial assistance from your state government
Don’t forget general healthcare costs  when you select your plan.
Typical cost factors include:
- Annual deductibleA deductible is the amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself., co-paymentA co-payment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a co-payment of $20 for office visits, you'll pay $20 to your doctor whenever you have an appointment., co-insuranceCo-insurance is the percentage of your medical costs that you pay after you meet your deductible. The remaining amount is paid by your insurance company. For example: If you have a $1,000 medical bill and your co-insurance is 20%, you'll pay $200. Your insurance company will cover the final $800. and out-of-pocket maximum amounts for all services
- Whether your current provider is in the plan’s network of providers. Call your provider’s office or insurance carrier to ask, or if you are a GoHealth member, connect with a GoHealth licensed agent to find out.
- Consider your care plan and visit frequency
- Associated costs for additional needed benefits
|Original Medicare Costs||Medicare Advantage Costs|
|You pay a Part B Premium.||Some plans cover up to 100% of the Part B premium.|
|-||Some Medicare Advantage plans have a $0 Part C premium.|
|You pay co-payments.||Some plans have a $0 co-pay.|
|Original Medicare does not have an out-of-pocket maximum.||Medicare Advantage plans do have an out-of-pocket maximum.|
Medicare Advantage (Part C) plans give you options. By law, all plans offer the same level of coverage as Part A and Part B. Medicare Advantage plans can’t charge more than Original Medicare for certain services like chemotherapy, dialysis and skilled nursing facility care.Skilled nursing facilities provide in-patient extended care with trained medical professionals to help with recovery from injury or illness and activities of daily living. These facilities provide physical and occupational therapists, speech pathologists and the medical professionals assist with medications, tube feedings and wound care. Skilled nursing stays are usually covered under Medicare Part A.
The extra benefits of Part C are important to review. For instance, most Part C plans include prescription drug benefits. If cost is most important to you, consider out-of-pocket costs between each Part C plan. Contact your provider or a licensed GoHealth insurance agent with questions about coverage.
Medicare Advantage (Part C)
Out-of-pocket costs: Out-of-pocket-costs vary. Plans may have lower out-of-pocket costs depending on the services you need.
- Compared to Original Medicare (Part A & B): You usually pay about 20% of the amount approved by Medicare after you meet your deductibles
Premiums: You may be responsible for paying a monthly premium for the Medicare Advantage Plan in addition to a premium for Part B. Some plans may help you pay the Part B premium, or they may cover the entire cost.
- Compared to Original Medicare (Part A & B): You pay a monthly premium for Part B.
Part D: Most Medicare Advantage plans include prescription drug coverage.
- Compared to Original Medicare (Part A & B): Prescription drug coverage is not included. There’s a separate premium for prescription drug coverage.
Yearly Limit: Medicare Advantage plans do have a yearly limit on out-of-pocket medical costs. You do not have to pay anything after you reach the limit.
- Compared to Original Medicare (Part A & B): You do not have a yearly limit on out-of-pocket costs.
Supplemental Coverage: You can not add supplemental coverage to a Medicare Advantage plan.
- Compared to Original Medicare (Part A & B): Supplemental Coverage (Medigap) can be added to your Original Medicare plan.
There are a variety of factors that can affect the cost of Medicare Advantage (Part C). Do you go to the doctor frequently? Are your primary doctors out-of-network?Out-of-network refers to doctors, hospitals and other providers that do not have an agreement to treat your health insurance company's clients. Visiting an out-of-network provider typically means more out-of-pocket costs and less coverage. Do you need a prescription drug plan? All of these elements can help you determine which plan is right for you.
Doctor visits and prescription drugs can make the cost of your plan go up or down.
Here’s what to consider:
- Part C does have a provider network  . Consider whether your providers are in- or out-of-network. Your costs will likely increase if you don’t stay in the network or if you travel often.
- Frequency of doctor visits can affect your out-of-pocket costs. Medicare Advantage has co-pays for doctor and specialist visits. If you see the doctor regularly, it may be cheaper to consider a MedigapMedicare Supplement Insurance (Medigap) are policies designed to provide coverage that Original Medicare (Parts A and B) do not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you'll need to pay. plan.
- Prescription drugs (Part D) are usually covered with a Medicare Advantage Plan. Each policy has a list of covered prescription drugs. With Original Medicare, you would have to join a separate Part D plan and pay its premium.
We aim to partner with you every step of the way and remove any confusion as you search for Medicare. We can help you understand what costs are involved with each plan, and find a policy that fits your lifestyle and needs.
Can I get help paying for Medicare Advantage?
You can still get help paying for Medicare Advantage, even though you can’t buy Supplemental Coverage. Medicare Savings Programs (MSP)Medicare Savings Programs help those with low incomes pay premiums and sometimes co-insurance for Medicare expenses. offered by your state can help pay for premiums, deductibles, co-insurance and co-payments if you qualify. Medicaid and/or Extra Help programs provide state plans to bundle benefits with Medicare Advantage beneficiaries. Low-income, disabilities or chronic health conditions may qualify you to receive financial assistance.
How do I choose a plan?
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.
What happens if I have Supplemental Coverage (Medigap) and join a Medicare Advantage Plan?
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.
What other cost details should I be aware of?
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.