Medicare Part C Coverage and Cost

Medicare Part C also called Medicare Advantage Plan (MA Plan) is offered by private companies approved by Medicare. Part C coverage is an alternative to Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). In addition, many Medicare Advantage Plans include Part D drug coverage. Moreover, MA Plans may cover extra benefits that Original Medicare does not cover such as dental, vision, and hearing.

Original Medicare Vs Medicare Advantage

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The cost of Original Medicare includes deductibles, coinsurance, and premiums of Medicare Part A and Part B. Medicare Advantage Plan costs may include deductibles, does include copays, and premiums. In addition to Medicare Part C costs, you also pay monthly premiums for Medicare Part A and Part B. Moreover, some Medicare Advantage Plans have zero monthly premium.

Original Medicare coverage is nationwide. Thus, you can chose any hospital or doctor in the United States that takes Medicare. On the other hand, Medicare Advantage Plans only cover hospitals and doctors inside their network for non-emergency care. So if you travel out of your network and need a hospital or doctor for a non-emergency, you will not insurance coverage. Moreover, if your doctor is not in the Medicare Advantage Plan network, you will need to find a different doctor in network. If you are considering Medicare Part C, ask your doctor if they participate in Medicare Advantage Plans.

Related Article: Medicare Parts coverage and cost in 2020

Medicare Part C Hospital Coverage

Your Medicare Part C (Medicare Advantage Plan) includes the following types of Hospital Coverage:

  • Hospital inpatient care
  • Skilled Nursing Facility inpatient care
  • Hospice care
  • Home Health care

What is Medicare Part C coverage for hospital care?

When you are admitted to the hospital as an inpatient and the hospital accepts Medicare, then Part C pays for your “room and board” in the hospital. The Medicare Advantage Plan is going to pay for a semi-private hospital room with a bed for you, three meals per day, and the nurse that visits you. In addition, MA Plan pays for medications furnished to you by the hospital and any necessary lab services or medical supplies.

Skilled Nursing Facility (SNF) care

Medicare Part C pays for skilled nursing care for a limited time at a Skilled Nursing Facility (SNF). This is typically provided for rehabilitation patients that do not require long-term care services. Medicare Advantage Plan covered services in a SNF include, but are not limited to:

Medicare Part C coverage
  • Physical therapy
  • Occupation therapy
  • Speech-language pathology services
  • Medical social services
  • Medications
  • Ambulance transportation (when other transportation endangers health)
  • Dietary counseling
  • Swing bed services

Hospice Care

Medicare Part C pays for your hospice care. When you have a terminal illness, hospice care can include any or all of the following services:

  • Doctor services
  • Nursing care
  • Medical equipment, such as wheelchairs or walkers
  • Medical Prescription drugs for symptoms control or pain relief
Medicare Part C coverage
  • Hospice aide and homemaker services
  • Physical therapy services
  • Occupational therapy services
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term respite care

Home Health Care

Medicare Part C covers home health care which includes a wide range of services administered in your home for an illness or injury. For example, skilled home health care services include:

  • Wound care for pressure sores or a surgical wound
  • Patient and caregiver education
  • Intravenous or nutrition therapy
  • Injections
  • Monitoring serious illness and unstable health status

The goal of home health care is to help you get better, regain your independence, and become as self-sufficient as possible.

Medicare Part C Medical Coverage

In addition to hospital coverage, Medicare Part C includes the following Medical Coverage:

  • Doctor Visits
  • Preventive Screenings
  • Mobility Equipment

Your Medicare Part C medical coverage is for stays at any hospital or medical facility for less than 24 hours (even if your stay occurs overnight). As part of your Medicare Advantage Plan it covers medically necessary services and supplies to treat your health condition. For example, Part C includes outpatient preventive services such as your annual flu shot and annual wellness visit to prevent illness. In addition, Medicare Part C covers medical screening tests such as cardiovascular disease and colorectal cancer screenings to detect your health conditions early so treatment is most effective. Furthermore, your Medicare Advantage Plan covers ambulance services and durable medical equipment.

Ambulance Service

Medicare Part C covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility. However, your Medicare Advantage Plan will only cover ambulance service to the nearest appropriate medical facility that is able to provide for your medical needs. In addition, your MA plan may pay emergency ambulance transportation in an airplane or helicopter to a hospital if you need rapid medical transport.

Preventive Screening for Diabetes

Medicare Part C covers a number of preventive screenings. For example, your Medicare Advantage Plan covers Diabetes screening and supplies. Diabetes affects 30.3 million Americans. In other words, 9.4% of the United States population has diabetes. Moreover, 7.6 million seniors (1 out of 4) age 65 or older are diagnosed with diabetes. Therefore, diabetes screening can determine whether you are one of these millions of people with diabetes.

When diabetes is caught early, it can be effectively managed. However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney damage, and nerve damage. Medicare Part C covers diabetes screening if your doctor determines you are at risk or diagnosed with prediabetes. In addition to diabetes screening, your Medicare Advantage Plan covers diabetes supplies such as glucose test strips and blood sugar testing monitors.

Preventive Screening for Hepatitis

What is hepatitis? It is a medical condition that causes inflammation of your liver. You may have hepatitis and not know it because there are few or no symptoms. Therefore, it is important you get screened because hepatitis can lead to jaundice, nausea, and in rare cases death. Moreover, some forms of hepatitis may cause cirrhosis and liver cancer.

Mobility Equipment

Medicare Part C covers mobility equipment such as canes, walkers, scooters, and wheelchairs under the following condition: you have a disability which prevents you from doing the following activities: bathing, toileting, personal care, feeding, and dressing. If your doctor or healthcare professional certifies you can not perform these activities, then your Medicare Advantage plan will cover your mobility device.

How much does Medicare Part C cost per month?

To enroll in Medicare Advantage Plan (Part C), you must also be enrolled in Medicare Part A and Part B. Since most seniors have a zero premium for Part A, the common monthly cost for Medicare Part C is Medicare Part B premium plus Medicare Advantage premium. However, your total monthly cost for Medicare Advantage Plan includes Part A, Part B, and Part C premiums.

In 2020, the standard premium for Medicare Part B is $144.60. According to a press release on September 24, 2019 from Centers for Medicare and Medicaid Services, Medicare Advantage average monthly premium was $26.87 in 2019. However, in 2020 Medicare Part C cost per month is expected to decrease 14 percent to $23. Therefore, the total expected monthly cost in 2020 for Medicare Advantage Plan and Medicare Part B is $167.60.

Medicare Advantage Drug Coverage and Extra Benefits

Unlike Original Medicare, Medicare Advantage Plans usually include prescription drug coverage. To get similar drug coverage with Original Medicare you need to join a separate Medicare Part D plan.

Medicare Advantage Plans may include extra benefit such as vision, hearing, dental, and silver sneakers. You can review your plans summary of benefits for more details.