What is Medicare Part C?

If you've been following along with our series, you're now experts in Original Medicare. You now that Original Medicare is composed of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). 

Alone, they cover your Medicare covered medical expenses at 80-20 coinsurance split, but only after the deductible has been met. This is good enough coverage for a small group of individuals, but for those who need help with prescription coverage and want more comprehensive medical coverage, Original Medicare just isn't enough.

You need to be enrolled, or be enrolling into BOTH Medicare Part A and Medicare Part B to be eligible for any Medicare Advantage Plan or Medigap Policy..

When you hear the term "Part C" being mentioned, know that the conversation is about Medicare Advantage Plans. Medicare Advantage Plans are often mentioned as Part C because they take the place of Original Medicare; Medicare Advantage encompasses both Medicare Part A and Medicare Part B in one plan, usually with added benefits like vision or dental.

Medicare Advantage Plans can come in multiple forms. In Nevada they are:

• HMO
• PPO

How Does Medicare Advantage Cost So Little?

Medicare Advantage Plans are provided by private insurers, and take the place of Medicare. What happens is that Medicare pays participating private insurers a set dollar amount to take medical responsibility for beneficiaries. This is good for Medicare, as it is a much more efficient way to manage care, and this is good for beneficiaries because private insurers can usually offer much more benefits than what Original Medicare is can cover.

Be aware that under a Medicare Advantage Plan, you are going to be required to get services and supplies from a set network of providers. 

What do Medicare Advantage Plans cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.

Extra services that may be covered under Medicare Advantage Plans in Nevada include:

• Vision
• Hearing
• Dental
• Health and wellness programs​
• Emergency Care (national and international)
• Medicare prescription drug coverage (Part D) at no extra cost​​

Medicare Advantage Plans typically work off of copayments to protect the Medicare beneficiary from financial hardship, and many of those copays can be as low as zero dollars. They also offer there members a maximum out-of-pocket to protect them from overly expensive medical expenses. Meaning that once a member reaches a certain dollar amount with regards to their medical expenses, they would no longer pay medical for the rest of the plan year.

This is a much more affordable option to Original Medicare, as Original Medicare does not offer any stop loss protection. 

Comprehensive Medicare Solutions contracts with all the major insurance carriers in Nevada and can help any beneficiary with their insurance decision. Our advisors work with clients on a one-on-one basis to help them find the best tailored plan option for their needs. Reach out to one of our Comprehensive Medicare Solution Advisors if you are interested in learning more any Medicare Advantage Plan in Nevada.