Understanding the Costs of Medicare Part C

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 ^[1] 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

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 ^[2] . 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.