What is a Medicare Advantage Part C plan?  What is Medicare Part C?  What is an “all-in-one” Medicare plan?

The truth is… they’re all the same thing.  Any plan that you’re interested in that is identified as a Medicare Advantage Part C plan (MA) or an “all-in-one” plan is Part C.

Medicare Advantage Part C is one of 2 ways that you can get your Medicare benefits.  Typically, a Part C plan will include:

• Medicare Part A (pays 80% hospital)
• Medicare Part B (pays 80% medical)
• Medicare Part D (drug coverage)

Part C plans are offered by many insurance companies that contract with Medicare, such as Humana, Aetna and  Wellcare, just to name a few.

If you don’t have a Medicare Advantage Part C plan

If you don’t enroll in a Part C plan and you have Medicare Part A and Part B, then you’re getting those benefits (80% hospital and medical) provided to you directly by Medicare.  When you enroll in a Part C plan, you agree to get your Part A and Part B benefits directly from the Part C plan, not Medicare- which is still only 80% coverage.  Part C plans ARE NOT Medicare Supplement (Medigap) insurance plans, they simply help you manage the other 20% Medicare doesn’t cover.  However, this is after you pay your set copay or coinsurance first- up to the maximum out of pocket you could possibly pay in a given year.

How a Medicare Advantage Part C plan pays with Medicare

Before the Part C plan pays, you will have to pay any set co-pay or co-insurance if applicable- for that particular service or procedure.  All of the co-pay and co-insurance payments that you make go toward your maximum out-of-pocket for the Part C plan you’re enrolled in… for that calendar year.  Then it starts over the next year.

What to expect with ANY Medicare Advantage Part C plan

Medicare Part C (MA) plans provide your Medicare Part A and Part B benefits in a different way than Original Medicare.  Before enrolling in a Part C plan, consider the points below:

• Would you be comfortable only seeing doctors who are in a health insurance plan’s network or do you want to always be able to see any doctor/specialist you choose? (With some plans, you can see any doctor you choose who accepts Medicare.  With other plans, there is a network of doctors you can see.  Medicare Supplement (Medigap) insurance plans allow you to use any hospital or doctor that accepts Medicare.)
• How do you feel about having your primary care physician coordinate your overall healthcare? (One benefit of this arrangement is that your care is managed and overseen by a doctor or team of doctors.  A drawback is that you cannot go directly to a specialist.)
• Looking ahead, how often do you plan to travel or be away from your primary home? (Different coverage options contain different network restrictions.  If you are away from home frequently, you will probably want coverage without network restrictions, such as a Medicare Supplement plan.)
• What are your payment preferences? (There is a trade-off between how much you pay in monthly premiums and what you pay when you’re admitted to a hospital or when you see a doctor.  The more you pay in monthly premiums, generally the less you pay when you need services or procedures.  With low or $0 premium Part C MA plans, you can expect to pay more when you get hospital or medical care, though your plan will have a maximum out-of-pocket limit (up to $7550 per year, as of 2021).
• Do you take medications that are generally more expensive, such as higher tier drugs? (Be careful here.  Before enrolling into any Part C plan that has the Part D Rx coverage included, you must make sure you know what your drug costs will be using the drug coverage included in that Medicare Advantage plan.)

What usually attracts people to consider a Part C plan is that plans can range in price anywhere from $0 premium per month on up to $100 or more in premium per month.  Plans may include drug coverage, dental and vision care- and even may include Silver Sneakers (GYM membership).

The premiums for Part C plans depend on the area in which you live (your county) and what’s available.  There are many Part C plans that are $0 premium per month.  In addition, some plans provide a Part B premium reduction (2021 Part B standard premium $148.50/mo paid to Medicare) for enrolling.

Disclaimer:  Since you have to have Medicare Part A and Medicare Part B in order to enroll into a MAPD plan, you will still have to continue to pay your Part B premium each month to Medicare- even if the MAPD plan has a $0 premium.

Medicare Advantage Part C in 2021

In late September, the Centers for Medicare & Medicaid Services (CMS)—the federal agency that oversees the Medicare program—released an overview of the upcoming year in Medicare Advantage Part C and the Part D prescription drug program.  Among the notable inclusions, CMS expects more people to join Part C plans than ever before, shows a sharp increase in the number of plans available, and reveals the number of plans that will offer expanded benefits.

Determining whether a Medicare Advantage Part C plan is the right choice for you

Determining whether a Part C plan is best for your individual circumstances can be a very complicated decision.  One of my concerns is that many people with Medicare do not have easy access to all of the tools and information they need to make those decisions.  Previous research has made clear that people with Medicare often do not end up in the best plan for their needs, which can mean they spend more than they should or may even face having to switch doctors to stay in the plan’s network.

Unfortunately, this difficulty will be worse due to the proliferation of NEW Part C plans for the upcoming plan year and the new, complicated offerings that people will need to wade through.

The CMS overview shows an increase from 3,100 Part C plans offered nationally to 3,700, with over 91% of beneficiaries having to choose between 10 or more plans.

In addition, CMS is allowing Part C plans new flexibilities to offer certain supplemental benefits.  While we support increasing the benefits people with Medicare receive from the program, CMS has not provided enough guidance to ensure these benefits are explained thoroughly to people who might choose to enroll.

My thoughts and your next steps

I think that many beneficiaries and their families will be confused by the number of options and will not get the proper support to make the best choice for their circumstances.  This is where I come in and can help you decide if a Medicare Advantage Part C plan is right for you and what you can expect when using the plan.

There is also good news in the overview: Medicare Advantage plans and Part D plan premiums have gone down slightly and access to both types of plans will be widespread.  This means that beneficiaries who would benefit from these offerings will have access to them.  Even though it’s a good sign that premiums went down as well as drug costs in general- that’s not the whole story.  Many people with Medicare struggle to afford their out-of-pocket costs, especially for their needed medications.

Don’t go it alone, everyone’s situation is different.  Your family member or neighbor may be happy with a Part C plan, but that doesn’t mean it will be right for you.  Get free help from a licensed professional who specializes in Medicare plans.  Leave me your information on my contact page or call me directly at (888) 901-4870.