Medicare Part C
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What is Medicare Part C?
Medicare Part C is Medicare’s private insurance arm. Medicare Part C plans, also called "Medicare Advantage plans" or "MA plans," offer many of the services that Medicare offers but with additional benefits.
Medicare and Medicare Advantage are two different types of health insurance
Medicare Advantage is the private insurance arm of Medicare and offers additional benefits such as hearing, eye and dental coverage
While Medicare Advantage may be more cost-effective, beneficiaries are limited in where they can go to access health services
Medicare vs. Medicare Advantage
Medicare and MA plans are both for adults 65 or older. However, they differ in what types of services they cover.
Medicare offers hospital insurance (Part A) and medical insurance (Part B). As you’d expect, this means that Medicare covers hospital visits and outpatient visits. If you want prescription drug coverage, you can pay additional money for it through Medicare Part D. You can also opt-in for supplemental coverage to help cover your copays.
A key benefit of Medicare is that you can go to any doctor or hospital that accepts Medicare insurance. This is also a reminder that not every provider will take Medicare insurance coverage.
MA plans are offered through private insurers that contract with Medicare. So, there are a bunch of private insurers that offer different types of MA plans. These plans include Medicare Part A, Part B, Part D and extra benefits. What are the extra benefits? Some may include vision, dental and hearing coverage as well as fitness memberships.
The Good and The Bad
MA plans offer more benefits than Original Medicare and may cost you less in premiums and copays. MA plans also limit out-of-pocket expenses, meaning that once you pay your maximum amount for health services, you pay nothing else for the remainder of the year. On the other hand, Medicare has no maximum for out-of-pocket expenses, so they are essentially limitless.
On the flip side, MA plans may limit your freedom of choice in where you go to see your doctor. Because MA plans are typically managed care, you can only see certain providers within your plan’s network. While in Original Medicare you can visit any provider that accepts Medicare, MA requires you to stay within the insurer’s network. If you want to go outside your network, you may be paying for all your care out-of-pocket.
Additionally, to prevent misuse and overuse of care, MA plans typically require a doctor’s referral and prior authorization. For example, you need your primary care physician to refer you to a specialist in order for your MA insurer to cover your visit with the specialist.
Outside the Huddle
Medicare Advantage vs. Medigap | Investopedia