Why do i need medicare part c

Medicare Part C — also known as Medicare Advantage — covers everything Original Medicare does, plus a few extra benefits. But these plans also come with some restrictions. We break down the basics so you can choose a Medicare plan that fits your needs. 

When you’re new to the world of Medicare coverage, you might feel like you’re swimming in a giant bowl of alphabet soup. There are Parts A and B for Original Medicare. There’s Part D for prescription drugs. And there’s Part C, which is also known as Medicare Advantage. 

“Medicare Advantage is basically a private Medicare,” says Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation. “It’s regulated by the government but run by insurers.” 

But that’s just the first important fact to know. Here, we tackle your top questions about Part C plans so you can find the health insurance that best fits your life.  

What does Medicare Part C cover? 

Think of Medicare Advantage as “bundled” plans: They include everything Original Medicare does and often more, such as coverage for prescription drugs, as well as vision, hearing and dental care. Some even include fitness benefits. 

What is Medicare Part C coverage for inpatient care? 

Inpatient care — meaning you’ve been admitted to a hospital — is traditionally covered by Medicare Part A. But if you opt for Medicare Part C, you still get all the coverage of Part A, including: 

• Inpatient care in a hospital, including a semi-private room, general nursing, medication, and other hospital services and supplies that you’ll need. This applies to long-term care hospitals, rehabilitation facilities, and psychiatric care in inpatient psychiatric facilities.
• Inpatient care in a skilled nursing facility, including semi-private rooms, meals, nursing and therapy services, and other medical services. 
• Hospice care, which includes comfort care such as pain relief medications or equipment, hospice aide services, and other forms of care. 
• Home health care, including part-time or intermittent skilled nursing care, physical therapy, and occupational therapy. You’ll qualify for home health services if you have trouble leaving your home without help or should stay at home due to your condition.
• Inpatient care in a religious non-medical health care institution, which includes inpatient hospital or skilled nursing facility care. (Medicare won’t, however, cover religious items.) 

One important difference to know: Your out-of-pocket costs will vary for each type of plan.   

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What is Medicare Part C coverage for outpatient care? 

Outpatient care — meaning emergency or observational services, lab tests, or X-rays — is traditionally covered by Medicare Part B. But if you opt for Medicare Part C, you’ll get all the coverage of Part B, including: 

• Doctor visits (including primary care doctor visits and specialist visits) 
• Lab tests and X-rays 
• Ambulance services for an emergency 
• Mental health services 
• Durable medical equipment such as walkers and wheelchairs 
• Preventive tests and vaccines, including flu shots and heart disease, diabetes, certain cancers, and depression screenings 
• Physical therapy 
• Occupational therapy 
• Speech and language pathology 
• Diabetes equipment and supplies 
• Acupuncture (up to 12 acupuncture visits in 90 days for chronic low back pain) 

If you have Medicare Part C, you may have different copayments, coinsurance, and deductibles than you would with Original Medicare. 

What is Medicare Part C coverage for extra benefits? 

Original Medicare doesn’t offer drug coverage — which differs from Medicare Part C. “You can choose a Medicare Advantage plan that comes with a drug benefit so you don’t have to pick up a separate Part D plan,” says Donovan.  

The approved drugs will be listed in the plan you select, so be sure to confirm that your medications are covered before you enroll. (We make comparing plans easy. Try our tool now.) 

Medicare Part C may offer other perks too, such as: 

• Fitness benefits, including gym memberships and exercise classes 
• Routine dental care, including cleanings, X-rays, and dentures 
• Routine vision care, including contacts and eyeglasses 
• Routine hearing care, including hearing aids 

Keep in mind, though, that not all Medicare Part C plans cover extra benefits in the same way. For example, some Medicare Part C plans might only cover “Medicare-covered dental benefits” — meaning dental care that’s needed for an accident or a disease of the jaw. If your Medicare Part C covers dental benefits more extensively, you may have a higher monthly premium for that coverage. 

How does Medicare Part C compare to Original Medicare? 

Medicare Part C and Original Medicare have different costs and different rules regarding coverage for providers, services, and drug plans. Here’s how the two plans can differ: 

Original Medicare Medicare Part C You can go to any doctor or hospital in the U.S. that accepts Medicare.    You may have to use your plan’s network of doctors and providers for non-urgent care. You usually won’t need a referral to see a specialist.    You may need to get a referral if you want to see a specialist.  Your coinsurance — the portion of the cost you pay for — is typically 20% of the Medicare-approved amount of Part B services. You’ll pay this after you meet your deductible.     Out-of-pocket costs vary from plan to plan and from one service to another. You’ll pay a monthly premium for Part B. If you have Medicare drug coverage (Part D), you’ll pay a separate premium for that as well.     You’ll pay the monthly Part B premium and the plan’s premium, if there is one.  There’s no yearly limit on what you pay out of pocket.    You’ll have a yearly limit on what services will be paid for out of pocket. Once you reach this limit, you won’t pay anything for hospital or routine health care for the rest of the year.    You can buy Medigap, which can help pay for any remaining out-of-pocket costs you may have (for example, your 20% coinsurance).     You can’t buy — and don’t need — Medigap. You usually won’t have to get a service approved ahead of time for it to be covered under your plan.       You’ll sometimes be able to get a service approved ahead of time for it to be covered under your plan, called pre-authorization. You won’t be covered for additional benefits like eye exams, most dental care, and other routine exams.    You’ll probably be covered for extra benefits like vision, hearing, and dental services. You generally aren’t covered for medical care outside the U.S. (If you’re traveling, you may be able to buy a Medigap policy that covers emergency care outside the U.S.)   You generally aren’t covered for medical care outside the U.S. Some supplemental coverage covers international emergency care, but you can’t buy Medigap.     If you split your time living in more than one state, you’ll be covered by any doctor in the U.S. who accepts Medicare.  If you split your time between states, your plan may limit your provider network to your place of residency (the state in which you pay taxes), but check with your insurance plan to be sure. If your network is limited to one state or area, you may want to buy supplemental coverage. 

What should I do if my Medicare Part C plan doesn’t cover something I need? 

If you’re denied coverage for something you need, the first thing you may be able to do is file an appeal. You can appeal for a health care service, supply, item, or prescription drug that you think you should be able to get or that you already got. You also can appeal to pay less than you originally were requested to pay. 

If your appeal is denied or if you have other frustrations with your plan, you can switch Medicare Advantage plans during the Medicare Open Enrollment Period, which is October 15 to December 7 every year or during the Medicare Advantage Open Enrollment Period, which is January 1 to March 31 each year.  

Ready to compare Medicare Advantage plans near you? Find a plan that fits your budget and covers your doctor and prescriptions now.    

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Sources

1. Centers for Medicare & Medicaid, Medicare & You 2022: The Official U.S. Government Medicare Handbook, https://www.medicare.gov/media/10991  
2. U.S. Department of Health & Human Services, What Is Medicare Part C?, August 3, 2021. https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html  
3. Medicare.gov, How Do Medicare Advantage Plans Work?, https://www.medicare.gov/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work  
4. Medicare.org, Medicare for Snowbirds Living in Two States & Dual Residency, 2022, https://www.medicare.org/articles/medicare-for-snowbirds-living-in-two-states-dual-residency/  
5. Centers for Medicare & Medicaid, Medicare Dental Coverage, December 1, 2021,  https://www.cms.gov/Medicare/Coverage/MedicareDentalCoverage  

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