Why Would I Need Medicare Part C?

Medicare Part C, mainly referred to as Medicare Advantage, is an all-in-one alternative to Original Medicare. It comes with some eye-catching perks like fitness benefits, dental and vision benefits, and sometimes even no monthly premium.

If you’re wondering why you might need Medicare Part C, we’re going to uncover the details.

Disclaimer: We do not offer every plan available in your area. 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. This article is meant for informational purposes only and is not attempting to steer you to any specific plan.

What is Medicare Part C?

Medicare Part C, also known as Medicare Advantage, is a type of health insurance plan offered by private insurance companies approved by Medicare.

It provides comprehensive coverage for all the benefits of Original Medicare (Part A and Part B), as well as additional benefits such as vision, dental, and prescription drug coverage.

Unlike Original Medicare, which is a government-run health insurance program, Medicare Part C is provided by private insurers who are contracted with Medicare.

These private insurers must offer at least the same level of coverage as Original Medicare, but they may also provide additional benefits and services beyond what is covered by Original Medicare.

Advantages of Medicare Part C

There are several advantages to enrolling in Medicare Part C (Medicare Advantage), including:

1. ‍Comprehensive coverage: Medicare Part C plans are required to offer the same benefits as Original Medicare (Parts A and Part B) but may also provide additional benefits such as prescription drug coverage, vision, dental, and hearing services.‍
2. Potential cost savings: Most Medicare Part C plans have lower premiums than Medicare Supplements. Additionally, some plans may offer extra benefits, such as gym memberships or transportation services, at no additional cost.‍
3. Simplified administration: With Medicare Part C, all your health care coverage is provided by one insurance plan, rather than having to manage separate coverage for different services. This can make it easier to understand and manage your health care costs. It also means you only need one medical insurance card instead of several.‍
4. Health and wellness programs: Some Medicare Part C plans offer wellness programs, such as fitness classes or smoking cessation programs, to help you maintain or improve your health.

Disadvantages of Medicare Part C

While there are certainly advantages of Medicare Part C, there are also some cons to consider:

1. ‍Limited provider network: Medicare Part C plans typically have a restricted network of doctors, hospitals, and other health care providers that you can use. If you see a provider outside of the network, you may be responsible for paying higher out-of-pocket costs or the full cost of the service.
2. ‍Possibility of higher out-of-pocket costs for some services: While most Medicare Part C plans may have a lower premium than Original Medicare paired with a supplement, they typically have higher out-of-pocket costs for certain services, such as hospital stays or skilled nursing facility care. That’s why some describe Medicare Part C plans as “pay as you go” plans.

1. Limited plan options: Medicare Part C plans are offered by private insurance companies, and plan availability varies by county. In some areas, there may be limited options for Medicare Part C plans, which can make it difficult to find a plan that meets your needs.‍
2. Possible changes to benefits and premiums: Medicare Part C plans can change their benefits and premiums from year to year, which can make it difficult to predict your costs and coverage over time.‍
3. Managed care: with Medicare Part C plans, your insurance company can make decisions about your healthcare. You may have to do things like step therapy, where you are required to try a less expensive drug before a more expensive one, even if your doctor wants to prescribe the more expensive one first.

Medicare Part C Might Be for You If…

So, do you need Medicare Part C? No, you don’t need it.

But, it could be a great health insurance option for you if some of these statements ring true:

• You prefer a very low monthly premium in exchange for more out-of-pocket costs each time you see a physician or need care
• You don’t travel much and are not a snowbird
• Your prescriptions are mostly common, generic medications‍
• Your doctors, hospitals, and pharmacies are in-network with the Part C plan you’re interested in‍
• Extra benefits like no-cost dental cleanings, hearing exams, eye exams, and fitness benefits are important to you
• You’re pretty healthy and don’t anticipate needing to see any physicians outside of a regular annual check-up

If you identify with several of these statements, you may seriously consider choosing Medicare Part C instead of Original Medicare paired with a supplemental policy.

Conclusion

Medicare Part C has many advantages, like low premiums and extra benefits that help cover routine dental, vision, and hearing expenses. However, they can get pricey if you have a hospital stay, and the provider networks can be problematic.

While you don’t need a Medicare Part C plan, it’s definitely something to consider when deciding what coverage to choose as you turn 65.

If we can help you by answering questions and looking at what plans are available in your county, we would love to be a resource for you. You can schedule a call right on our website at a day and time that’s convenient for you.

Disclaimer: We do not offer every plan available in your area. 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.