For countless older Americans, Medicare is a lifesaver when it comes to doctor and hospital bills. But that’s not enough for everyone. The elderly lady who’s missing out on her grandchildren’s laughter because she can’t afford hearing aids, or the elderly man who’s losing too much weight because his teeth are so bad he’s having trouble eating aren’t getting much benefit from Medicare. But that can change with a Medicare Part C plan to help pay additional medical costs.
Many seniors don’t realize that they can get more than the basic Part A and Part B Medicare plans, and in many cases the additional costs aren’t that high. They’re affordable, and can really offset how much a person has to pay out to get good medical care and have their health needs met. If you’re one of the people who has Parts A and B but nothing else, or if you’re about to be Medicare eligible, it may be time for you to look into what a Medicare Part C plan can offer you.
Medicare Advantage Plans Can Help
Medicare Part C is also called Medicare Advantage. It is a supplemental, additional plan for people who already have Part A and Part B. If you get into a Part C plan, you still have to pay your Part B premiums, as well. These plans are actually private health insurance options that are approved by Medicare, and they cover Part A, Part B, and additional benefits. Depending on the exact plan you choose, you may be covered for any number of additional things at a fair price.
Vision, dental, and prescription drug coverage are common with Medicare Part C plans, as are hearing coverage benefits. However, because Advantage plans are somewhat different from traditional Medicare you’ll need to be in your network to receive the maximum level of coverage benefits. That may mean you’ll need to switch doctors or hospitals for your care, and that you’ll also need to go to a different pharmacy to get your prescriptions. While that’s not ideal for everyone, the savings can be well worth it.
Why Isn’t This Coverage Automatic?
When people reach the age to qualify for Medicare, they aren’t automatically enrolled. They need to sign up, but they’ll get Part A and Part B when they do so. That covers doctor visits and hospital stays, but it doesn’t cover eye appointments, hearing aids, dental care, or medications. If they want those things they must sign up for them, as well. When they do that they’ll have more coverage, but that coverage isn’t free. The costs needed to cover this additional care have to be paid by those who sign up, which is part of the reason Part C is not automatic coverage when a certain age is reached.
Additionally, not everyone who is eligible for Part C coverage actually wants a Medicare Advantage plan. Some people simply don’t want the extra cost, don’t need the additional coverage, or have medical coverage from other companies that takes care of dental, vision, or other needs. There’s no real point in paying for overlapping coverage, as that becomes just a waste of money. Instead of forcing people to pay for something they may not need, they can choose whether they want a Medicare advantage plan or whether they would prefer to do without those additional benefits and their additional costs.
What Does Medicare Part C Cover?
Medicare Advantage plans cover a wide range of medical needs, depending on your individual needs and the specific plan that you choose. Some people want as much coverage as they can possibly get, while others need a lower level of coverage that only addresses a particular aspect of their health. For example, someone may need hearing aids, but not take medication. You may wear glasses, but have perfect teeth. No matter what you need, there are Medicare Part C plans that can cover specific issues.
here are pros and cons financially, and also from a need standpoint, so it’s worthwhile to ask plenty of questions and go over your medical needs with someone you trust. Then you can make an informed decision as to whether you should enroll in Medicare Part C.
How Much Does This Coverage Cost?
The cost of Part C coverage varies, depending on the type of plan you want and other factors. You can get plans both with and without prescription drug coverage, and those plans will be different prices. Additionally, where you live and what you’re paying for any other Medicare supplements you already have may affect your cost. Being very low on income or having other health insurance can also be factors for the cost of a Medicare Advantage plan, so that’s worth considering, too.
It’s not just what you’ll pay for your plan premiums that you have to consider, either. It’s also which company you choose and what kinds of out-of-pocket costs you’ll be asked to pay. Because Medicare Advantage is operated through private companies that contract with Medicare, these companies may all be a little bit different in what they charge and how they bill, along with their out-of-pocket costs, in-network requirements, and other factors. Where you live may limit the plans you can purchase.
Before you choose a Medicare Part C plan, make sure you’re focused on the questions you need to ask about that plan. Look at more than just the monthly premiums, because so many other things will ultimately affect the total price of the plan itself. You don’t want to get a great premium, only to find that the out-of-pocket costs are too high or the nearest in-network doctor is 100 miles away from you. Doing your research before signing up is an important part of choosing a Part C plan.
Handling Prescription Drug Coverage
If you already have a Part D Prescription Drug plan and you want to sign up for Part C, you’ll be disenrolled from Part D when you sign up for Part C. That’s because you can’t have two plans that cover the same thing, and Part C offers the Part D drug benefit as a part of it. Of course, you’ll have the same concerns with the coverage gap in prescription drugs in Part C as you do in Part D, so you’ll need to be mindful of what many people call the “donut hole” in their medication coverage.
While it doesn’t apply to everyone, the donut hole refers to the coverage gap that appears when people have medications that cost more than their coverage limit but that don’t cost enough to reach catastrophic coverage needs. If you fall into that category for the year, you could find yourself paying more than you expected for your medications. You want to be prepared for that, so you can get additional help to ensure that your medications are available to you as needed.
Avoiding the “Donut Hole”
There are some specific ways you can avoid the coverage gap that comes with Part C’s prescription drug coverage. Asking your doctor for generic or lower-priced medication is one option, as is switching your pharmacy to one that’s in-network and charges less. You can also request low-income help if you qualify, and ask your doctor or other medical professional for suggestions to reduce your medication costs while still treating your conditions properly.
In some cases you may have to budget for the donut hole because there isn’t a way to avoid it, but many people can reduce their medication costs through an honest conversation with their doctor and some changes to the way they get the drugs they need to keep them healthy. Avoiding the donut hole can save you a lot of money, and that money can be better used for other things you might need or want, instead of being spent on medications that Medicare Part C can help you pay for.
How Do You Get Medicare Part C?
You can get Medicare Part C the same way you get other types of Medicare options: by signing up during an enrollment period. If you’re just now becoming eligible for Medicare for the first time, you’ll receive information about enrollment. You don’t have to sign up for anything beyond Part A and Part B if you don’t want to, but that initial enrollment period is a good time to sign up for any other coverage you feel you’ll need.
For anyone who already has Medicare and wants to sign up for Part C, there are enrollment periods that can be used. In some cases you may be permitted to sign up on a special enrollment, instead of only during open enrollment options that are available to everyone. Asking questions is important, and can help you have the knowledge you need to decide whether you want to sign up for Part C, and when that might be the best choice to meet your medical needs.
Is This Permanent Coverage?
Once you sign up for Part C, or Medicare Advantage, it’s yours as long as you keep paying your premiums. You won’t be disenrolled and your insurance won’t be canceled unless there are significant changes made to the actual Medicare system. You can sign up for Part C with the confidence that the insurance you choose will be there for you in the future. Once you enroll and start paying your premiums, you can begin to use the coverage you’ve signed up for so you can get any medical needs taken care of.
If you decide Medicare Part C coverage isn’t for you, you don’t have to keep it. You can change your plan during an open enrollment period, and that means you can disenroll during that time, as well. Some people don’t need the level of coverage that Part C offers, or they would prefer not to have the in-network restrictions or extra premium costs required. If you’re one of those people, an open enrollment period gives you options to consider so you can make changes.
What If You Have Other Insurance?
For people who already have other insurance, getting Medicare Part C might not make sense. Other insurance plans may cover dental, hearing, vision, and medications, so you would be paying for coverage that would overlap the other coverage you’re also paying for. Unless Medicare Advantage offers you significant benefits over and above what your other insurance is giving you, it’s likely not necessary for you to enroll in it if you have other types of strong insurance coverage.
What’s the Bottom Line With Part C Coverage?
The bottom line with Medicare Part C coverage is that it offers help for people who need vision, dental, hearing, or prescription drug coverage. There are different types of plans, so you can get only certain types of coverage that you might need or want, now or in the future. That can help you protect your health for a lower cost, and can also give you the opportunity to get treatment for something you might not have been able to afford to have treated in the past.
Dental work, hearing aids, glasses, and medications can all be very costly depending on what your specific needs actually are. Keep that in mind, and you’ll be able to decide whether a Medicare Advantage plan is right for you. Then, if you choose one, you’ll want to make sure you’re selecting the right company to give you good premiums, low out-of-pocket costs, and a strong network of medical professionals near your home. That way you’ll really have the opportunity to get the help you need, and you won’t have to pay too much or travel too far to get it. That can improve your quality of life and make things easier for you, overall.