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What services does Medicare Part C cover, what are the costs and how to find out about eligibility?

All the information you need about Medicare Part C, the associated costs, requirements and the eligibility rules.

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Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B). It is offered by private insurance companies approved by Medicare and provides additional benefits. This article will explore the services covered by Medicare Part C, the associated costs, requirements, and how to determine if you are eligible.

What services does Medicare Part C cover?

Medicare Part C plans are required to cover all the services that Original Medicare covers, but they often include additional benefits. Here’s a breakdown of what you can expect:

  • Hospital and medical services:
    • Inpatient hospital care: Includes hospital stays, inpatient mental health services, and rehabilitation services.
    • Skilled nursing facility care: Covers limited stays in a skilled nursing facility.
    • Home health care: Limited home health care services.
    • Hospice care: Hospice care is covered, but it is provided by Original Medicare even if you are enrolled in a Medicare Advantage plan.
  • Outpatient services:
    • Doctor visits: Includes visits to primary care physicians and specialists.
    • Preventive services: Such as vaccinations, screenings, and annual wellness visits.
    • Emergency services: Emergency room care and ambulance transportation.
    • Durable medical equipment: Items like wheelchairs, walkers, and home oxygen equipment.
    • Mental health services: Outpatient mental health services and counseling.
  • Additional benefits:
    • Prescription drug coverage: Most Medicare Advantage plans include Part D prescription drug coverage.
    • Vision, dental, and hearing: Many plans offer coverage for routine vision, dental, and hearing care.
    • Wellness programs: Some plans include gym memberships, meal delivery services, and transportation to medical appointments.

What are the costs of Medicare Part C?

The costs associated with Medicare Part C can vary widely depending on the plan and the provider. Here are some common costs to consider:

  • Monthly premiums:
    • You must continue to pay your Part B premium, which is $164.90 per month in 2024. Some Medicare Advantage plans may also have an additional monthly premium.
  • Deductibles and copayments:
    • Deductibles: Some plans have annual deductibles for medical services and prescription drugs.
    • Copayments and co-insurance: You may have to pay a copayment or coinsurance for services such as doctor visits, hospital stays, and prescription drugs.
  • Out-of-Pocket maximum:
    • Medicare Advantage plans have an out-of-pocket maximum limit, which can protect you from high medical costs. Once you reach this limit, the plan covers 100% of covered services for the rest of the year.

Requirements for Medicare Part C

To enroll in a Medicare Part C plan, you must meet certain requirements:

  • Enrollment in original Medicare:
    • You must be enrolled in both Medicare Part A and Part B.
  • Residency:
    • You must live in the service area of the Medicare Advantage plan you wish to join.
  • Enrollment periods:
    • You can enroll during your Initial Enrollment Period (IEP), which starts three months before you turn 65 and ends three months after the month you turn 65.
    • If you miss your IEP, you can enroll during the Annual Enrollment Period (AEP) from October 15 to December 7 each year.
    • There is also a Medicare Advantage Open Enrollment Period from January 1 to March 31 each year, but this is only for those already enrolled in a Medicare Advantage plan who wish to switch plans or return to Original Medicare.

How to know if you’re eligible for Medicare Part C

Eligibility for Medicare Part C is straightforward:

  • Age and citizenship:
    • You must be at least 65 years old and a U.S. citizen or a legal permanent resident for at least five continuous years.
  • Disability:
    • If you are under 65 and have a qualifying disability, you may be eligible for Medicare after receiving Social Security Disability Insurance (SSDI) for 24 months.
  • Specific Conditions:
    • Individuals with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) are eligible for Medicare without the 24-month waiting period.

You can also check your eligibility on the Medicare website, contact your local Social Security office or call Medicare at 1-800-MEDICARE (1-800-633-4227)

Medicare Part C offers a comprehensive alternative to Original Medicare, providing additional benefits and coverage options. Understanding the services covered, associated costs, requirements, and eligibility criteria can help you make an informed decision about your healthcare coverage. If you meet the eligibility requirements and are looking for more extensive coverage, Medicare Part C might be the right choice for you.

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