If you search online for “Medicare Part C Plans,” you will soon be looking at the websites of private insurance companies that offer them.
You will be overwhelmed with information, but you will also notice that these websites are similar in a lot of ways. They all feature pictures of smiling people who are old enough to be on Medicare. They are often walking energetically in the great outdoors, sometimes in groups of people about the same age. Sometimes people are walking dogs. Apparently, dogs like Medicare Part C Plans too.
Another similarity is that all those companies want your business. They make it easy for you to speak to salespeople.
But although those companies seem to have a lot in common, there could be important differences that can affect how much you pay for coverage or, in some cases, in the quality and number of services their Medicare Part C plans will pay for.
Your finances and your health could be affected by the Medicare Advantage plan you choose. So don’t just call a company that has a nice-looking website and sign up.
What are the differences in Medicare Part C plans and what should you be looking for? We will answer those questions in today’s post. But before we do, let’s answer a more fundamental question first . . .
What is Medicare Part C?
Medicare Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by private insurance companies that contract with the federal government. Medicare Advantage plans provide all of the benefits of Original Medicare (Part A and Part B) and often include additional benefits such as prescription drug coverage, dental, vision, hearing, and wellness programs.
To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B, reside in the plan’s service area, and continue to pay your Medicare Part B premium. When you enroll in a Medicare Advantage plan, you receive your health care benefits through the private insurance company offering the plan, rather than through Medicare directly.
Medicare Advantage plans must cover all of the services that Original Medicare covers. But Medicare Advantage plans also offer additional benefits not covered by Original Medicare, such as routine vision, hearing, and dental care, as well as gym memberships and transportation to medical appointments.
It’s important to carefully review the details of any Medicare Advantage plan you are considering, including the plan’s provider network, costs, and benefits, to ensure it meets your healthcare needs and budget.
How Do You Pay for Medicare Part C?
Medicare pays a fixed amount for your care every month to the company that administers your Medicare Part C plan. And you pay the rest – an additional fee to the insurance company that provides the plan.
These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.
What Are HMOs and PPOs?
They are two different kinds of Medicare Part C Plans. The Medicare Part C Plan you buy will be one of them:
- An HMO (Health Management Organization) is a health insurance plan that will only cover the costs of visiting doctors and other care providers who are contracted to work with the HMO. This type of plan generally won’t cover out-of-network care except in emergencies. There could be geographical limitations as well, meaning that you have to reside in a certain geographical area in order to join.
- A PPO (Preferred Provider Organization) is a Plan that will pay for virtually all your healthcare expenditures as long as you visit in-network providers. A PPO will also provide some coverage for out-of-network providers, often with a co-pay required.
What Should You Consider When Shopping for a Medicare Part C Plan?
When comparing Medicare Part C Plans, there are some key factors to consider, including:
- Out-of-pocket costs: These include deductible and coinsurance amounts, as well as other fees associated with services. Be sure to compare the out-of-pocket costs so you know exactly what you will be paying for care.
- The network of providers: Check to see what healthcare providers are in the plan’s network. It is important to make sure your current doctors and care providers participate in the Plan you are considering.
- Part D Coverage: Medicare Part D coverage is important, as it covers prescription drugs. Be sure to check what pharmacies and drugs are covered by your plan to make sure it covers the medications you need.
- Extras: Some Medicare Part C plans offer additional benefits, such as vision, dental, or hearing coverage. Check to see what extras are included in the plans you are considering.
- The actual costs to you: Compare the monthly premiums and potential annual out-of-pocket costs of the plans you are considering, as well as any additional costs, such as copays or deductibles.
- Customer service: Be sure to read customer reviews of the plans you are considering to see how satisfied people are. This can help you get a better understanding of what customer service to expect should you need to use the plan.
- Brand and reputation: What kind of ratings and reviews have people posted online about the company you are considering?
And Be Sure to Check Out the CMS Rating for the Plan You’re Considering
The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure the experiences Medicare beneficiaries have with their health plans. It is called the CMS Star Rating Program. Health plans are rated on a scale of 1 to 5 stars, with 5 being the highest. The Star Rating Program is intended to raise the quality of care for Medicare beneficiaries and to help consumers like you compare health plans more easily.
You can find the Star Rating for the plan you are considering by calling one of CoverRight licensed agents or by visiting Medicare.gov.
A 30-minute call can clarify everything you need to know to pick the Medicare Part C Plan that will work the hardest for you. There is never a charge to you for speaking with us – not even if you sign up for one of the plans we steer you toward.
And Then Go Take that Walk Outdoors
After you have that conversation, you will feel relieved. So relieved that you can take the kind of stroll that is shown on the websites of the companies that sell Medicare Advantage Plans. Heck, you can even invite some friends to take that walk with you. You will be so relieved, you can even take your dog.
The stress will melt away because you will know you have gotten the Medicare Part C plan that is designed to fit your personal situation.
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CoverRight is on a mission to make the Medicare plan selection process easy to understand. We are here to help you compare Medicare plans and find the one best suited to your specific situation. Try the platform for yourself.
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