Understanding the Costs of Medicare Part C
Key Takeaways
- Medicare Advantage plans may set a range of monthly premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. . Many only charge the Medicare Part B premium, and some may even help with that cost.
- Medicare Advantage plans substitute for Medicare Parts A and B, and Medicare Advantage Prescription Drug plans 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 include extra benefits.
- 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.
- 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 Advantage plans to choose from, it can be challenging to compare costs and make the right choice to fit your healthcare needs and budget. The plan you enroll in affects how much you’ll pay in monthly premiums, an annual deductible, and copays or coinsurance for certain services.
We’re here to help navigate your choices.
What Is the Cost of Medicare Part C?
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 reach the plan’s limit, you’ll pay nothing for covered services for the remainder of the plan year.
Medicare Advantage Prescription Drug plans include Medicare Part D coverage for medications, and plans offer additional benefits like dental, vision, and hearing. People on Original Medicare must purchase Part D plans separately, The same is true for Medicare Supplement (also known as Medigap) plans, which help with out-of-pocket costs.
Additional Cost Considerations
When comparing Medicare plans, you need to consider the full picture of your healthcare annual costs. Keep in mind:
- Medicare Advantage plans vary and so do the costs. The type of plan you choose can affect your annual expenses.
- Your monthly premiums are what you pay to have active health insurance. Most Medicare Advantage plans charge a monthly premium.
- If you have a lower income and limited resources, you may be eligible to receive Medicaid or financial assistance from your state government.
- The annual deductible is how much you pay before your insurance kicks in. For specific services you may be charged a copayment (a set amount) or coinsurance (a percentage of the cost). Medicare Advantage plans set an out-of-pocket maximum, which limits how much you’ll pay each year.
- Check whether your preferred doctors are in the provider network for the plan you want.
- Look into the costs for any care or procedures you expect to need in the next year.
- Learn about the details of any additional benefits, including what services are covered and how much you’ll pay.
Original Medicare vs. Medicare Advantage Costs
Original Medicare (Part A and B)
Premium
Most people pay no premium for Medicare Part A (hospital insurance), but do pay a premium for Part B (medical insurance). If you add Medigap or Medicare Part D prescription drug coverage, these plans also charge premiums.
Copays
If your healthcare provider accepts assignment (which means they take the amount set by Medicare as full payment), you are charged a Medicare-approved copayment or coinsurance for most services.
Out-of-pocket Maximum
Not applicable. Members pay 20% of the cost of most services unless they choose to add Medigap, which helps with out-of-pocket costs.
Medicare Advantage (Part C)
Premium
You may pay the plan’s premium in addition to the Part B monthly premium. However, many plans only charge the Part B premium amount, and some may help with that cost.
Copays
Each plan sets its own copayment and coinsurance costs.
Out-of-pocket Maximum
Your plan will set an out-of-pocket maximum. Your plan pays 100% of your costs for the rest of the year after you reach the limit.
Have questions about your Medicare coverage?
What Is Included With Medicare Part C?
A Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B), and must offer offers at least the same coverage. Medicare Advantage Prescription Drug plans include Part D coverage for medications, and Part C plans often feature additional benefits like dental, hearing, and vision.
When you have Medicare Part C, your benefits ID card replaces your Medicare ‘Red, White & Blue’ card at every visit.
What Costs Do I Pay With Medicare Part C?
Your costs with a Medicare Advantage plan vary based on factors like how often you visit your doctor, whether your healthcare providers are in-network, and your prescription drug needs. Consider these tips:
- Part C plans usually have a provider network. Check whether your preferred doctors are in-network when choosing a plan. Receiving care out-of-network may increase your costs considerably.
- Copays can add up, especially 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.
- As you compare Medicare Advantage Prescription Drug plans, make sure your medications are covered and learn how much you’ll pay for a regular supply.
Still have questions? GoHealth has the answers you need.
FAQs
Can I get help paying for Medicare Advantage?
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.
How do I choose a plan?
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.
What happens if I have a Medicare Supplement plan (Medigap) and join a Medicare Advantage Plan?
Medicare does not allow people to have both a Medicare Supplement (Medigap) and a Medicare Advantage Plan. Contact your insurance provider to cancel the policy if you enroll in Medicare Advantage.
What other details should I know about costs?
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.