So, what’s covered? Basics of Medicare Part C

If you’re thinking about signing up for Medicare, navigating how it works might feel confusing. A good place to start is familiarizing yourself with the ABCs of Medicare. Below, we’ll cover the basics of Medicare Part C.

What is Medicare Part C?

Medicare Part C, also known as Medicare Advantage, is a comprehensive health insurance plan offered by private insurance companies approved by Medicare. This alternative to Original Medicare bundles together Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), providing you with a one-stop shop for your healthcare needs. Many include Medicare Part D (prescription drug coverage). 

At a minimum, all Medicare Advantage plans must offer the same level of coverage as Original Medicare. Medicare Advantage plans may also cover additional benefits not included in Original Medicare, such as vision, dental, and prescriptions. When signing up for a Medicare Advantage plan, you will need to continue to pay your monthly Part B premium.

If you enroll in a Medicare Advantage plan, you must use the plan’s network of providers to get care. Be sure to assess the quality and size of a plan’s network and see if your current providers will be in-network. You will be responsible for the charges if you get out-of-network care.

What does Medicare Part C cover?

At a minimum, all Medicare Advantage plans must offer the same level of coverage as Original Medicare. Medicare Advantage plans may also cover additional benefits not included in Original Medicare, such as vision, dental, and prescriptions. Here’s what Medicare Part C – aka Medicare Advantage — will typically include:

Hospital Services (Part A)

Medicare Part C includes coverage for various hospital services under Part A, such as:

  • Inpatient Care: This covers your stay in a hospital when you require treatment for a specific illness or condition.
  • Skilled Nursing Facility Stays: If you need skilled nursing care after a hospital stay, Medicare Part C may cover this service.
  • Hospice Care: Part A also covers hospice care for individuals facing a terminal illness, providing comfort and support during their final stages.

Medical Services (Part B)

Under Part B, Medicare Part C extends coverage to various medical services, including:

  • Outpatient Care: This encompasses services you receive without being admitted to a hospital, such as doctor’s office visits, outpatient surgeries, and diagnostic tests.
  • Preventive Services: Medicare Part C emphasizes preventative care, covering screenings, vaccinations, and annual wellness visits to detect and prevent health issues early on.
  • Doctor Visits: Access to a network of healthcare providers, including specialists, for consultations and medical advice.

Prescription Drug Coverage (Part D)

Many Medicare Advantage plans include Part D, which provides coverage for prescription drugs. This is a crucial addition, ensuring that you have access to necessary medications without incurring additional costs. 

  • Don’t assume that YOUR Medicare provider offers part D; some don’t. It’s important to check if Part D benefits are included in the Medicare Advantage plan you are interested in. 
  • Also, check to see if the plan covers the medications you take and if your pharmacy is in the network. You’ll need to buy a Part D plan for coverage if these benefits aren’t included. 

Additional Benefits

Some Medicare Part C plans offer extra benefits to enhance your overall well-being. You’ll want to check if your plan covers the following:

  • Vision Care: 
    • Regular eye exams to assess your vision health and detect potential issues early on.
    • Coverage for prescription eyeglasses, helping you maintain optimal vision.
    • Some plans may cover the cost of contact lenses as an alternative to traditional glasses.
  • Dental Care:
    • Routine dental exams, x-rays and cleanings to prevent and address oral health issues.
    • Coverage for basic dental procedures such as fillings and extractions.
    • In some cases, plans may cover major dental procedures like root canals or crowns.
  • Hearing:
    • Regular hearing tests to assess your auditory health, addressing one of the common health concerns among seniors.
    • Financial assistance or coverage for the cost of hearing aids, which can significantly improve the quality of life for those with hearing impairment.
  • Wellness: 
    • Access to fitness programs, gym memberships, or discounts on health-related services to encourage a healthy lifestyle.

What Medicare Part C doesn’t cover

Understanding the limitations of Medicare Part C is essential. Here are some areas where coverage is typically lacking:

  • Long-Term Care
    • Medicare Part C doesn’t cover extended nursing home or assisted living facility stays for ongoing, non-medical care.
  • Cosmetic Procedures
    • Non-essential cosmetic surgeries and procedures are generally not covered under Medicare Part C.
  • Certain Specialized Services
    • Some specialized or experimental treatments may not be covered, as Medicare Part C aims to provide essential and proven healthcare services.

How to enroll in Medicare Part C / Medicare Advantage

Before enrolling, ensure you meet the eligibility criteria. To join a Medicare Advantage Plan, you must: 

  • Have Part A and Part B. 
  • Live in the plan’s service area. 
  • Be a U.S. citizen or lawfully present in the U.S.

You can only join, switch, or drop a Medicare Advantage Plan during these enrollment periods: 

Open Enrollment Period 

Between October 15 and December 7 each year, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7). 

Medicare Advantage Open Enrollment Period 

During the Medicare Advantage Open Enrollment Period, which occurs annually from January 1 to March 31, you have the opportunity to make the following changes:

  • If you are currently enrolled in a Medicare Advantage Plan (with or without drug coverage), you can choose to switch to another Medicare Advantage Plan (with or without drug coverage).
  • Alternatively, you have the option to discontinue your Medicare Advantage Plan and revert to Original Medicare. During this period, you can also enroll in a standalone Medicare drug plan if needed.

However, within the Medicare Advantage Open Enrollment Period, if you are currently on Original Medicare, you are not allowed to:

  • Switch to a Medicare Advantage Plan.
  • Enroll in a Medicare drug plan.
  • Change from one Medicare drug plan to another.

Two Important Reminders! 

  • During Medicare Advantage Open Enrollment, you can make only one change, and it’s effective the first day of the following month. 
  • If you’re returning to Original Medicare and joining a drug plan, cancellation of enrollment from your Medicare Advantage Plan occurs automatically when you join a Part D drug plan.

Still have questions?

Picking the right Medicare Advantage plan can be a big deal. If you’ve got questions or need help, don’t hesitate to reach out to the experts at Guided Solutions. We are here to give you the info and support you need when it comes to all things Medicare.


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