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 (MAPD) or an “all-in-one” plan is Part C.

Medicare Advantage Part C is one of two ways to get your Medicare benefits

Typically, a Part C plan will include:

• Medicare Part A (pays 80% of Hospital)
• Medicare Part B (pays 80% of Doctors/Physicians)
• Medicare Part D (Prescription Drug Coverage)

Many insurance companies that contract with Medicare offer Part C plans, such as Anthem, Humana, Aetna, and Wellcare.

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

If you don’t enroll in a Part C plan and have Original Medicare Parts A and B, you get those benefits (80% Hospital and Doctor) directly from Medicare.

When enrolling 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 only provides 80% coverage. Part C plans are NOT Medicare Supplement (Medigap) insurance plans. Part C plans help you manage the other 20% Medicare doesn’t cover, but plans don’t provide 100% coverage. With Part C plans, you pay your set copay or coinsurance first- up to the maximum out-of-pocket you could pay in a given year.

How a Medicare Advantage Part C plan pays with Medicare

Before the Part C plan pays, you must pay any set copay or coinsurance, if applicable- for that particular service or procedure. All your copay and coinsurance payments 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—premiums, benefits, and the maximum out-of-pocket change annually.

What to expect with ANY Medicare Advantage Part C plan

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

• Do you want to be able to keep your doctors? (Medicare Advantage plans use networks. You must ensure your provider accepts your plan to save the most money. 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 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 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 Doctor care, though your plan will have a maximum out-of-pocket limit.
• Do you take medications that are generally more expensive, such as higher-tier drugs? (Be careful here. Before enrolling into any Medicare Advantage Part C plan that includes Part D Rx coverage, you must ensure you know your drug costs when using the drug coverage included in that Medicare Advantage plan. This is something we can help you with!)

What usually attracts people to Part C plans is low premiums. Most are $0 monthly; however, some Medicare Advantage plans have a premium. Premiums can range anywhere from $0 to $100+ per month. The premiums for Part C plans depend on the area in which you live (your county) and what’s available.

Plans may include drug coverage, dental and vision care, grocery cards, a Part B give-back (2024 Part B standard premium $174.70/mo paid to Medicare), and even Silver Sneakers (gym membership).

Disclaimer: Since you must have Medicare Parts A and B to enroll in a MAPD plan, you must continue to pay your Part B monthly premium to Medicare- even if the MAPD plan has a $0 premium.

Medicare Advantage Part C Annual Benefit Changes

Each September, the Centers for Medicare & Medicaid Services (CMS)—the federal agency that oversees the Medicare program—releases 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 circumstances can be complicated. One of my concerns is that many people with Medicare do not have easy access to the tools and information needed 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 worsen 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.

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.

**Beware of the cold-calling call-center agencies who will sell your information, and the agent you end up with won’t be around in the future! Work with an independent agent with a proven track record of helping people navigate Medicare each year. 🙂

My thoughts and your next steps

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. I can help you decide if a Medicare Advantage Part C plan is right for you and what you can expect when using the plan.

Don’t go it alone; everyone’s situation is different. A Medicare Advantage, Part C plan, may be suitable for your family member or a neighbor, but that doesn’t mean it will be right for you.

Get free help from a licensed professional specializing in your state’s Medicare plans!

CLICK HERE to schedule a call with Chad!

You can also call or text (404) 996-0045 to schedule a quick call.