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What Is Medicare Part C?

Medicare Part C also called Medicare Advantage Plan (MA Plan) is offered by private companies approved by Medicare and is an alternative to Original Medicare Part A and Part B. Medicare Advantage plans can include Part D prescription drugs. Moreover, MA Plans may cover extra benefits that Original Medicare does not cover.

Medicare Part C Coverage & Cost

Medicare Part C hospital coverage includes inpatient care in a hospital and skilled nursing facility. Furthermore, it includes hospice and home health care. In addition to hospital coverage, Part C medical coverage includes doctor visits, preventive screenings, ambulance services, and durable medical equipment.

To enroll in Part C, you need to first enroll in Medicare Part A and Part B. Beneficiaries new to Medicare starting January 1, 2020 must pay Part B monthly premiums. The standard Part B premium is $170.10 in 2022. You may also have to pay Part C premiums, which may include prescription drug coverage. 

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How Senior Healthcare Direct Can Help You Get Coverage

When it comes to Medicare Part C coverage, it can be hard to know if it’s the right choice. Our experienced professionals at Senior Healthcare Direct can help you shop and compare Medicare Advantage (MA) plans. Let our licensed agents help you find an MA plan with the coverage and cost that is right for you. 

We can also help you apply for Medicare Part A, Part B, and Part D. Each type of coverage offers additional protections for you. Medicare Part A offers hospital coverage; Part B focuses on outpatient medical care; and Medicare Part D provides prescription drug coverage. 

Medicare Advantage Vs Original Medicare

Premium Differences

According to KFF.org, the average number of Medicare Advantage (MA) plans available to beneficiaries for 2022 has increased to 39. Among these MA plans 31 include prescription drug coverage.

However, Original Medicare beneficiaries pay Part D premiums for prescription drug coverage. The cost of Part D vary by plan, geographic area (the state where you live), and your taxable income from the last two years. KFF projects a $43 average monthly premium for Medicare Part D stand-alone drug plans in 2022.

Max Out-of-Pocket Limit

The maximum out-of-pocket (OOP) limit for in-network services is $7,550 excluding End-Stage Renal Disease (ESRD). The max OOP including ESRD is $8,174. However, Medicare Advantage Plans limits vary from plan-to-plan. For example, your maximum out-of-pocket limit could be as low as $0.

In comparison, Original Medicare has no out-of-pocket limit. Therefore, the amount you pay for Medicare services may be more than $7,550. For example, you could pay $10,000 or more. To reduce your out-of-pocket expenses, we recommend you consider a Medicare Supplement (Medigap) plan.

Medicare Part C Hospital Coverage

Your Medicare Part C (Medicare Advantage Plan) includes the following types of Hospital Coverage:

  • Hospital Inpatient Care

  • Skilled Nursing Facility Inpatient Care

  • Hospice Care

  • Home Health Care

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What Is Medicare Part C Coverage For Hospital Care?

When you are admitted to the hospital as an inpatient and the hospital accepts Medicare, then Part C pays for your “room and board” in the hospital. The Medicare Advantage Plan is going to pay for a semi-private hospital room with a bed for you, three meals per day, and the nurse that visits you. In addition, MA Plans pays for medications furnished to you by the hospital and any necessary lab services or medical supplies.

Medicare Part C pays for skilled nursing care for a limited time at a Skilled Nursing Facility (SNF).  Medicare Advantage plan covered services in a SNF include, but are not limited to:

  • Physical therapy

  • Occupation therapy

  • Speech-language pathology services

  • Medical social services

  • Medications

  • Ambulance transportation (when other transportation endangers health)

  • Dietary counseling

  • Swing bed services

Medicare Part C Medical Coverage

In addition to hospital coverage, Medicare Part C includes the following Medical Coverage:

  • Doctor Visits

  • Preventive Screenings

  • Mobility Equipment

Your Medicare Part C medical coverage is for stays at any hospital or medical facility for less than 24 hours (even if your stay occurs overnight). As part of your Medicare Advantage plan, it covers medically necessary services and supplies to treat your health condition.

For example, Part C includes outpatient preventive services such as your annual flu shot and annual wellness visit to prevent illness. Furthermore, Medicare Part C covers medical screening tests such as cardiovascular disease and colorectal cancer screenings to detect your health conditions early so treatment is most effective.

Medicare Advantage plans also cover ambulance services and durable medical equipment.

Medicare Part C covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility. However, your Medicare Advantage plan will only cover ambulance service to the nearest appropriate medical facility that is able to provide for your medical needs. In addition, your MA plan may pay emergency ambulance transportation in an airplane or helicopter to a hospital if you need rapid medical transport.

Medicare Part C covers a number of preventive screenings. For example, your Medicare Advantage Plan covers diabetes screenings and supplies.

According to the National Diabetes Statistic Report 2020, Diabetes affected 34.2 million Americans in 2018. In other words, 10.5% of the US population had diabetes. Moreover, 11.5 million seniors ages 65 and older were diagnosed with diabetes. Therefore, it is important you know whether you are one of those millions of people who have diabetes.

When diabetes is caught early, it can be effectively managed. However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney damage, and nerve damage.


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