Demystifying Medicare Part C: Understanding the Coverage You Deserve

Each fall, people are inundated with Medicare Part C ads encouraging people to switch their health insurance.

Medicare Part C, or more commonly called Medicare Advantage Plans, have grown in popularity over the years with more than half (51%) of all Medicare beneficiaries enrolled in a Part C plan.1 For current Medicare beneficiaries or people approaching eligibility for the first time, a question they may ask themselves is “Why do I need Medicare Part C?”

So, let’s go over “why” you need a Medicare Part C plan, its coverage and if it’s right for you.

What is Medicare Part C Used For?

Medicare Part C, a.k.a Medicare Advantage, is a comprehensive alternative to traditional Medicare (Part A and Part B). It’s offered by private insurance companies approved by Medicare and provides all the benefits of Part A and Part B, and often includes additional benefits such as prescription drug coverage (Medicare Part D), vision, dental and hearing coverage. Medicare Part C plans are designed to offer a one-stop solution for all your health care needs, providing a more integrated approach to managing your health.

The primary purpose of Medicare Part C is to streamline health care coverage and enhance the overall health care experience for beneficiaries. This streamlined approach can be particularly beneficial for individuals seeking a more integrated and convenient health care solution.

What Does Medicare Part C Cover?

Medicare Part C covers a wide range of health care services. As stated above, Medicare Part C includes your Original Medicare Part A (your hospital coverage) and Part B (your medical coverage).

Medicare Part A focuses on inpatient hospital care for hospital stays, skilled nursing facilities, hospice care and some home health care.

Medicare Part B covers two main types of services: medically necessary services – services that are needed to diagnose or treat your medical condition – and preventative services. Preventative services can include flu shots, diabetes screenings, mammograms, a one-time “Welcome to Medicare” visit and more.

While you can get Medicare Parts A and B without signing up for Medicare Part C, what tips the scale for why many people get Part C is the extra benefits that come with most plans.

While the exact combination of benefits can vary by policy and insurance provider, some of the more common extra benefits include:

• Vision
• Fitness memberships
• Telehealth appointments
• Hearing
• Dental

Other benefits that you may also find in a Medicare Part C plan include over-the-counter benefits, meal benefits and transportation to and from appointments. It’s important to note that not all plans have all these benefits. That said, having a combination of these benefits, plus Original Medicare and prescription drug coverage “all-in-one plan” makes Medicare Part C an appealing option for many Medicare beneficiaries.

Medicare Part C Eligibility Requirements

To be eligible for Medicare Part C, you must first be enrolled in both Medicare Part A and Part B. This means that you need to meet the eligibility criteria for Original Medicare before you can consider enrolling in a Part C plan. In addition to being enrolled in Part A and Part B, you must live in the service area of the Medicare Advantage Plan you wish to join.

Furthermore, there are specific enrollment periods during which you can join, switch or drop a Medicare Part C plan. The Initial Enrollment Period (IEP) is the first opportunity for most individuals to sign up for Medicare Part C, and it generally occurs around the time you are turning 65 and first eligible for Medicare. There’s also an Annual Enrollment Period (AEP) during which you can make changes to your Medicare coverage, including joining, switching, or dropping a Medicare Part C plan.

It’s important to note that eligibility requirements and enrollment periods may vary based on your specific circumstances, such as whether you have a qualifying disability or qualify for a Special Enrollment Period (SEP) due to certain life events. Understanding these requirements and periods is crucial for determining when and how you can access Medicare Part C plans.

Comparing Medicare Part C with Other Medicare Options

It’s important to consider factors such as cost, coverage, provider networks and flexibility when comparing Medicare Part C plans and other Medicare options. Original Medicare allows you to see any doctor or health care provider that accepts Medicare, while Medicare Part C plans may have specific networks of providers that you must use to receive full benefits. Additionally, costs and coverage for services can vary between Original Medicare and Medicare Part C plans, so it’s crucial to assess how each option aligns with your health care preferences and budget.

Common Misconceptions About Medicare Part C

Misconceptions about Medicare Part C abound, and it’s essential to address these misunderstandings to ensure that individuals have accurate information when considering their Medicare options. One common misconception is that Medicare Part C is the same as Medicare Supplement Insurance, also known as Medigap. In reality, Medicare Part C provides an alternative way to receive Medicare benefits by enrolling in a private insurance plan, while Medigap policies are designed to supplement Original Medicare by helping to pay for costs that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles.

Another misconception is that Medicare Part C plans are overly restrictive in terms of provider networks. While some Medicare Part C plans have network restrictions, others offer more flexibility in choosing health care providers. It’s important to review the details of each plan to understand its provider network and how it aligns with your preferences for accessing health care services.

Why Do You Need a Medicare Part C Plan?

The question of “Why do I need Medicare Part C?” can be a very personal question. However, there are some common reasons why people choose to enroll in a Medicare Part C plan. These reasons often come down to convenience, benefits and cost.

For many people, having an “all-in-one” plan that includes Medicare Part A, Part B, prescription drug coverage and extra benefits like dental, vision, hearing and a fitness membership is appealing. Especially when you consider how you would have to enroll in separate plans for much of the coverage offered in a Part C plan.

As stated above, the “extra benefits” Medicare Part C provides can be an enticing option for many people, especially prescription drugs. In 2023, more than half of all Medicare Part D enrollees (56%, or 28.3 million) are enrolled in a Medicare Part C plan with prescription drug coverage.²

While Original Medicare has deductibles, copayments and coinsurance, Medicare Part C plans may offer out-of-pocket maximums, which can limit your annual health care expenses. Additionally, some plans have lower or even zero monthly premiums, making them an attractive option for individuals seeking comprehensive coverage at an affordable cost.

Choosing the Right Medicare Part C Plan

When evaluating Medicare Part C plans, it’s important to assess the coverage, costs, provider networks, and additional benefits offered by each plan to determine which one best meets your requirements.

Start by reviewing the coverage provided by each Medicare Part C plan, including inpatient and outpatient services, prescription drug coverage, and any extra benefits such as vision, dental, and hearing coverage. Consider how the plan addresses your specific health care needs and whether it offers the services and treatments essential for maintaining your health and well-being.

Cost is another critical aspect to evaluate when choosing a Medicare Part C plan. Compare the premiums, deductibles, copayments and coinsurance associated with each plan to understand the financial implications of enrolling in a particular plan. Additionally, consider any out-of-pocket maximums that may limit your annual health care expenses, as well as potential cost savings offered by the plan.

Provider networks play a vital role in accessing health care services under Medicare Part C. Consider whether the plan’s network of doctors, specialists, hospitals and other health care providers includes the professionals and facilities that you prefer to use. Assessing the accessibility and quality of care within the plan’s network is crucial for ensuring that you can receive the health care services you need.

Lastly, explore the additional benefits provided by each Medicare Part C plan, such as wellness programs, telehealth options, and other services that contribute to your overall health care experience. These extra benefits can enhance the value of the plan and support your efforts to maintain your health and well-being.

By carefully evaluating these factors, you can make an informed decision about choosing the right Medicare Part C plan that best suits your health care needs and aligns with your preferences and priorities.

Enrolling in Medicare Part C

Enrolling in Medicare Part C requires careful consideration of eligibility, enrollment periods and the specific details of the plans available to you. With everything to keep in mind, it helps to have someone in your corner to guide you through the enrollment process. That’s where Ensurem can be of assistance.

Ensurem has a team of licensed insurance agents ready to help you along your Medicare journey. Our licensed agents take your specific needs into account and narrow down the options for you so that you see plans that meet your eligibility. Once you find a plan that’s to your liking, our agents can enroll you in the plan if you qualify.

If you’re ready to explore Medicare Part C and determine the coverage that aligns with your needs, call the number on this page to speak with an Ensurem licensed agent. More of an online shopper? Check out Ensurem’s Medicare Part C Online Comparison Tool.