Medicare Part C refers to a Medicare Advantage plan, which combines original Medicare with a private insurance plan that is approved by Medicare. Medicare pays for the Original Medicare plan – which includes Part A and Part B – along with Part D prescription drug coverage. In the Medicare Advantage plan you would be responsible for some additional costs associated with the private insurance plan depending on the coverage you choose. There are different types of Medicare Advantage plans, the amount you pay will vary based on which plan you choose.
Because Medicare Part C bundles Original Medicare – Part A, Part B, and sometimes Part D – with private insurance plans, these are sometimes referred to as “bundled” Medicare plans. It’s important that you understand which portions of the plan you are responsible for paying, and what is covered under your own individual Medicare Part C plan.
What Does Medicare Part C Cover for Inpatient Care?
Medicare Part C includes Part A of Original Medicare, which is generally referred to as the inpatient hospital coverage of Medicare. You will be covered under Medicare’s rules if you need to go to the hospital for inpatient care. At a minimum, you would receive all Original Medicare benefits, with Medicare Part C, although your individual plan may have additional benefits included. Rest assured, you will always receive coverage for urgent and emergency care.
In addition to in-patient care at a hospital, Medicare Part A coverage also includes:
- Skilled nursing facility care: Under Medicare’s definition, skilled nursing facility care is short-term care that requires a health professional to provide services to you, such as IV antibiotics or wound care dressings.
- Nursing home care: Medicare has pretty specific rules for what it will pay for nursing home care, but in general this is inpatient care that doesn’t involve custodial care only, which would be things like getting dressed or helping with daily activities of living.
- Hospice care
- Home health care
Some services and medications offered or used while you are a patient in a hospital may not be covered by Medicare. Although inpatient care is covered by Medicare in general, there are rules to what that entails. For example, Medicare typically only covers semi-private rooms, so you won’t get covered for a private room that isn’t medically necessary.
What Does Medicare Part C Cover for Outpatient Care?
Medicare Part C includes Medicare Part B, which generally covers outpatient care services such as:
- Lab work
- Doctor visits, both for illness and preventative care
- Vaccines, like the flu shot
- Ambulance services (in an emergency)
- Mental health care
- Therapies, including occupational, physical and speech
- Durable medical equipment (DME)
- Some outpatient prescription drugs
You can always check if a service, test or item is covered by Medicare. In cases where you have been denied coverage, you do have the right to file an appeal.
Does Medicare Part C Cover Prescription Drugs?
The majority of Medicare Part C plans include Medicare Part D, which is prescription drug coverage.
The rules around prescription drug coverage with Medicare Part C are strict. If you purchase a Medicare Part C plan that offers its own prescription drug coverage while you are enrolled in Original Medicare or try to buy a separate drug plan, you will be automatically disenrolled and returned to just Original Medicare. To avoid that from happening, stick to a Part C plan that does not have prescription drug coverage and instead includes Part D for drug coverage.
There are two exceptions to this general rule. You are allowed to purchase a separate Medicare Prescription Drug Plan if your Medicare Advantage Plan:
- Is unable to offer drug coverage, as with a Medicare Medical Savings Account plan
- Does not offer prescription drug coverage, as with a Private Fee-for-Service plan
You’ll want to check with your Medicare representative or doctor to confirm what type of prescription drug coverage is best for you.
What Are The Additional Benefits of Medicare Part C Coverage?
A Medicare Part C plan allows you to “customize” your Medicare plan to include additional benefits and coverage that aren’t included in original Medicare alone. You get the full coverage of Original Medicare while having the opportunity to add on additional coverage that works best for you and your lifestyle.
For instance, while Original Medicare may cover things like doctor’s visits and a hospital stay, it doesn’t include coverage for vision or dental. A Medicare Advantage plan, on the other hand, can include all of the Original Medicare coverage, plus additional benefits such as:
- Vision coverage, including eye exams, glasses and contacts
- Hearing coverage, including hearing aids
- Dental coverage, including dentures and teeth cleaning
- Fitness program coverage, like gym memberships
- Adult daycare services
- Over-the-counter medications
- Some plans may also cover items like transportation and services that promote health and wellness
Some Medicare Part C plans also cover additional health care needs, such as providing transportation services to and from your doctor appointments, covering certain over-the-counter medications and offering other types of wellness services. There are also opportunities for individuals with chronic illnesses to customize a plan based on what benefits best serve them, which varying costs based on individual plans.