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Medicare Part C Coverage & Cost

Medicare Part C hospital coverage includes inpatient care in a hospital and skilled nursing facility. Furthermore, it includes hospice and home health care. In addition to hospital coverage, Part C medical coverage includes doctor visits, preventive screenings, ambulance services, and durable medical equipment.

To enroll in Part C, you need to first enroll in Medicare Part A and Part B. Beneficiaries new to Medicare starting January 1, 2020 must pay Part B monthly premiums. The standard Part B premium is $170.10 in 2022. You may also have to pay Part C premiums, which may include prescription drug coverage.

Medicare Advantage
Vs Original Medicare

Cost Comparisons

Coverage Comparisons

Premium Differences

According to KFF.org, the average number of Medicare Advantage (MA) plans available to beneficiaries for 2022 has increased to 39. Among these MA plan 31 include prescription drug coverage.

However, Original Medicare beneficiaries pay Part D premiums for prescription drug coverage. The cost of Part D vary by plan, geographic area (the state where you live), and your taxable income from the last two years. KFF projects a $43 average monthly premium for Medicare Part D stand-alone drug plans in 2022.

Max Out-of-Pocket Limit

The maximum out-of-pocket (OOP) limit for in-network services is $7,550 excluding End-Stage Renal Disease (ESRD). The max OOP including ESRD is $8,174. However, Medicare Advantage Plans limits vary from plan-to-plan. For example, your maximum out-of-pocket limit could be as low as $0. In comparison, Original Medicare has no out-of-pocket limit. Therefore, the amount you pay for Medicare services may be more than $7,550. For example, you could pay $10,000 or more. To reduce your out-of-pocket expenses, we recommend you consider a Medicare Supplement (Medigap) plan.

Original Medicare offers nationwide coverage and access to more doctors and hospitals than Part C plans. However, Medicare Advantage (MA) plans offer local (HMO) or regional (PPO) network coverage.

Medicare Advantage - HMO vs. PPO

HMO (Health Maintenance Organization) plans often require referrals from your primary card physician to see a specialist. Furthermore, HMOs do not provide out-of-network coverage, unless it's for emergency or urgent care. So, if you travel out of network and need a hospital or doctor for a non-emergency, your HMO will not cover it. Thus, HMO only covers in-network doctors and hospitals.

PPO (Preferred Provider Organization) plans allow you to see doctors outside your network, but it may cost you more.

MA Plan Extra Benefits

Medicare Advantage plans may offer you additional benefits, including: dental, vision, hearing, fitness program, and transportation. Before you join Medicare Part C, make sure you ask your doctors if they participate in MA plans.

Medicare Part C Hospital Coverage

Your Medicare Part C (Medicare Advantage Plan) includes the following types of Hospital Coverage:

Hospital Inpatient Care
Skilled Nursing Facility Inpatient Care
Hospice Care
Home Health Care

Medicare Advantage
Vs Original Medicare

When you are admitted to the hospital as an inpatient and the hospital accepts Medicare, then Part C pays for your “room and board” in the hospital. The Medicare Advantage Plan is going to pay for a semi-private hospital room with a bed for you, three meals per day, and the nurse that visits you. In addition, MA Plan pays for medications furnished to you by the hospital and any necessary lab services or medical supplies.

Skilled Nursing Facility (SNF) Care

Hospice Care

Home Health Care

Medicare Part C pays for skilled nursing care for a
limited time at a Skilled Nursing Facility (SNF).
Medicare Advantage plan covered services in a SNF include, but are not limited to:

Physical therapy
Occupation therapy
Speech-language pathology services
Medical social services
Medications
Ambulance transportation (when other transportation endangers health)
Dietary counseling
Swing bed services

Medicare Part C pays for your hospice care. When you have a terminal illness, hospice care can include any or all of the following services:

Doctor services
Nursing care
Medical equipment, such as wheelchairs or walkers
Medical Prescription drugs for symptoms control or pain relief
Hospice aide and homemaker services
Physical therapy services
Occupational therapy services
Speech-language pathology services
Social work services
Dietary counseling
Grief and loss counseling for you and your family
Short-term respite care

Medicare Part C covers home health care which includes a wide range of services administered in your home for an illness or injury. For example, skilled home health care services include:

Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status

The goal of home health care is to help you get better, regain your independence, and become as self-sufficient as possible.

Medicare Part C Medical Coverage

In addition to hospital coverage, Medicare Part C includes the following Medical Coverage:

Doctor Visits
Preventive Screenings
Mobility Equipment

Your Medicare Part C medical coverage is for stays at any hospital or medical facility for less than 24 hours (even if your stay occurs overnight). As part of your Medicare Advantage plan, it covers medically necessary services and supplies to treat your health condition.

For example, Part C includes outpatient preventive services such as your annual flu shot and annual wellness visit to prevent illness. Furthermore, Medicare Part C covers medical screening tests such as cardiovascular disease and colorectal cancer screenings to detect your health conditions early so treatment is most effective.

Medicare Advantage plans also cover ambulance services and durable medical equipment.

Medicare Part C covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility. However, your Medicare Advantage plan will only cover ambulance service to the nearest appropriate medical facility that is able to provide for your medical needs. In addition, your MA plan may pay emergency ambulance transportation in an airplane or helicopter to a hospital if you need rapid medical transport.

Preventive Screening For Diabetes

Preventive Screening For Hepatitis

Mobility Equipment

Medicare Part C covers a number of preventive screenings. For example, your Medicare Advantage Plan covers diabetes screening and supplies.
According to the National Diabetes Statistic Report 2020, Diabetes affected 34.2 million Americans in 2018. In other words, 10.5% of the US population had diabetes. Moreover, 11.5 million seniors ages 65 and older were diagnosed with diabetes. Therefore, it is important you know whether you are one of those millions of people who have diabetes.
When diabetes is caught early, it can be effectively managed. However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney damage, and nerve damage.

What is hepatitis?

Hepatitis is a medical condition that causes inflammation of your liver. You may have hepatitis and not know it because there are few or no symptoms. Therefore, it is important you get screened because hepatitis can lead to jaundice, nausea, and in rare cases death. Medicare also covers vaccines for COVID-19 and other communicable diseases, including:

Pneumococcal
Influenza
Shingles

Medicare Part C covers mobility equipment such as canes, walkers, scooters, and wheelchairs if you have a disability which prevents you from doing the following activities:

Bathing
Toileting
Personal Care
Feeding
Dressing

If your doctor or healthcare professional certifies you can not perform these activities, then your Medicare Advantage plan may cover mobility equipment.