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 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 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 plans to choose from, it can be challenging to compare costs and know what you will be required to pay. A licensed insurance agent can help you find the right coverage to fit your healthcare needs and budget.
Find the Medicare Advantage plan that meets your needs.
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.
Most Medicare Advantage plans include Medicare Part D prescription drug coverage and offer additional benefits like dental, vision, and hearing. People on Original Medicare must purchase Part D or Medicare Supplement plans separately.
Additional Cost Considerations
When comparing Medicare plans, you need to consider the full picture of your healthcare annual costs. Here are a few basic items to take into account when getting started with Medicare:
- 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
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 Medicare Supplement 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
- N/A
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.
Original Medicare does not have an out-of-pocket maximum. Members pay 20% of the cost of most services unless they choose to add a Medicare Supplement plan (Medigap), which helps out-of-pocket costs.
Have questions about your Medicare coverage?
What Is Included With Medicare Part C?
Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers at least the same coverage as Original Medicare. Medicare Part C plans often feature additional benefits like dental, hearing, vision, and prescription drug coverage.
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 can vary based on how often you visit your doctor, whether your primary doctor is in-network, and your prescription drug needs. When it’s time to compare your options, consider these tips:
- Part C plans usually have a provider network. 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 increase your costs considerably.
- 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 are usually covered with a Medicare Advantage Plan. To get coverage for most prescriptions, Original Medicare requires members to add a standalone Medicare Part D plan, 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, a GoHealth licensed insurance agent can help.
Looking for a plan with prescription drug coverage?
Can I get help paying for Medicare Advantage?
How do I choose a plan?
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?
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.
Sources
- Understanding Medicare Advantage Plans. Medicare.gov.
- What is Medicare Part C? HHS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.