Medicare Part C, also known as Medicare Advantage, is a form of Medicare in relation to private health insurance. In this section, you are able to receive Medicare benefits from a private health company contracted by the government to ensure coverage. However, these plans still require the same benefits of the original Part A and Part B Medicare plans, but can differ in rules, costs and coverage restrictions. Some plans also include Part D drug coverage as part of their benefits.

Types of Medicare Advantage Plans +

Before you join a Medicare Advantage plan, you must already have Medicare Part A and Part B. If these are included, your plan options can be one of the following:

  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNPs)
  • MSAs (Medical Savings Accounts)

We invite you to contact SBI Benefits today to speak with our insurance agent, Alberto Ochoa, to see if a Medicare Advantage plan in Las Vegas and Sparks, Nevada, is the right choice for you.

What Are the Costs of Medicare Part C Plan? +

Before enrolling in any plan, you must consider the costs. The costs for Medicare Advantage plans depend on their premiums, deductibles and co-payments.

Part C Medicare Premiums +

The cost of premiums varies plan by plan and can range between $0 to more than $200. You must already have Part A and B in a Medicare plan before enrollment. You will be required to pay your usual Part B premium as well as an additional premium required by your plan. The good news is many plans may pay a percentage of your Part B premium. Please be sure to confirm this with your plan.

Part C Medicare Deductibles +

Only a few Medicare Advantage Plans require you to pay an annual deductible in addition to your Part B deductible. If you have prescription drug coverage included in your plan, you may be charged for another deductible.

Copayments +

Copayments are what you are required to pay out of your own pocket to cover specific services, like doctor’s visits. They are a flat-rate fee configured in dollar amounts unlike coinsurance which is a set percentage found with traditional Medicare. Many plans can demand higher copayments if you see a provider out of network.Each year, these plans will set a specific amount they plan to collect for premiums, deductibles, and services. Because of this, each Part C plan can charge different out-of-pocket costs and have additional rules on how you receive your benefits. For example, you may need a referral to see a specialist or visit a provider who is part of the plan for non-emergency care.

The rules on how you get services may change each year, but what you pay may only change once a year, on January 1. If you are an existing Medicare beneficiary, the cap for your out-of-pocket maximum will be set to a limited amount depending on the calendar year. If you receive care out-of-network, you can anticipate the limit to be higher.

SNP Costs with Medicare Part C +

Special Needs Plans are Part C for individuals who:

  • Live with a serious chronic disease
  • Already have Medicare and Medicaid coverage
  • Currently reside in a selected nursing home
  • Live at home but need long-term nursing assistance that could qualify for a nursing home.

Most of the costs of SNPs are covered as long as you have Medicaid and Medicare. If you do not have assistance through Medicaid or Medicare, the costs will be comparable to the fees in a regular Medicare Advantage Plan.

Inpatient Care Coverage +

Under Original Medicare, they will pay for inpatient care through Medicare Plan A. Fortunately, Plan C has the same benefits as Part A, such as:

  • Hospital inpatient care
  • Home health care
  • Inpatient skilled nursing facility care

While they may have the same benefits, Plan C may have different cost sharing rates than Original Medicare has. But your hospice benefits will still be covered with Original Medicare.

Outpatient Care Coverage +

With Original Medicare, your outpatient care is covered by Medicare Part B. Outpatient care is classified as necessary medical services and preventative treatments used to treat and prevent diseases. These include:

  • Doctor visits (primary care and specialists)
  • Laboratory tests and X-rays
  • Flu shots and vaccinations
  • Emergency ambulance services
  • Inpatient and outpatient mental health services
  • Medical equipment such as wheelchairs and walkers
  • Speech and language pathology
  • Preventative tests
  • Physical and occupational therapy

Please note Medicare Part C may include different cost sharing amounts than Original Medicare.

Coverage for Additional Benefits +

Unlike Original Medicare, the prescription drugs you take at home are covered by Medicare Part C. You can find a list of the precise medication your plan covers in the plan formulary. Other benefits covered by Medicare Part C include:

  • Routine dental care including cleanings, X-rays and dentures
  • Necessary vision care and eye wear such as glasses and contacts
  • Hearing screenings and hearing aids
  • Exercise classes for health and fitness benefits

When reviewing, you may discover not all Medicare Part C plans provide the same level of coverage for extra benefits. For example, some plans may only provide “Medicare-covered dental benefits” such as dental care for injuries and disease in the jaw. If your Part C plan includes more extensive dental benefits, you may have a higher premium.

What if Medicaid Part C Does Not Cover What I Need? +

If you are ever denied coverage for something you need, the next step you can take is to file an appeal. This allows you to appeal for a health care service, supply or prescription medication you believe you are entitled to. You can also appeal to pay a lower amount than they originally asked of you.Should a situation occur when your appeal is denied, you are welcome to change Medicare Advantage plans during the Annual Election Period (AEP) between October 15 to December 7 every year.