What Does Medicare part C Cover?

Medicare Made Simple

What Does Medicare Part C Cover?

Medicare Part C is another name for Medicare Advantage. Medicare Part C is administered by private insurance companies contracted with Medicare. Medicare Advantage plans, or Medicare Part C plans, are comprehensive plans that include the same benefits of Medicare Parts A and B plus additional coverage. That’s important if you need more than what Original Medicare provides.

What is Medicare Part C coverage for inpatient care?

Under Original Medicare, inpatient care is generally covered by Medicare Part A. Medicare Part C covers the same benefits as Medicare Part A including:

Inpatient care in a hospital
Inpatient skilled nursing facility care

Medicare Part C will also cover:

Home health care

Medicare Part C may have different cost-sharing amounts for inpatient care and home health care than the Original Medicare has. With Medicare Advantage, your hospice care benefits will still be covered by Original Medicare.

What is Medicare Part C coverage for outpatient care?

Under Original Medicare, outpatient care is generally covered by Medicare Part B. Outpatient care includes medically necessary services and preventive services to prevent or detect disease. Medicare Part C covers the same benefits as Medicare Part B including:

Doctor visits (primary care doctor and specialists)
Laboratory tests and X-rays
Ambulance services in an emergency
Both inpatient and outpatient mental health services
Durable medical equipment such as walkers and wheelchairs
Preventative tests and vaccines, including flu shots
Physical therapy
Occupational therapy
Speech and language pathology

Medicare Part C may have different cost-sharing amounts for outpatient care than the Original Medicare has.

What is Medicare Part C coverage for extra benefits?

Unlike Original Medicare, Medicare Part C generally offers coverage for prescription drugs you take at home. The exact prescription drugs that are covered are listed in the plan’s formulary. Formularies may vary from plan to plan.

Other extra benefits that Medicare Part C may cover include:

Routine dental care including cleanings, x-rays, and dentures
Routine vision care including contacts and eyeglasses
Routine hearing care including hearing aids
Fitness benefits include exercise classes
Routine Foot Care
Chiropractic Visits

Not all Medicare Part C plans cover extra benefits in the same way. For example, some Medicare Part C plans may only cover “Medicare-covered dental benefits” which generally only means dental care in the event of an accident or disease of the jaw. If your Medicare Part C covers dental benefits more extensively, you may have a higher monthly premium for that coverage.

What should I do if my Medicare Part C plan doesn’t cover something I need?

If you are denied coverage for something you need, the first thing you may be able to do is file an appeal. You can appeal for a health care service, supply, item, or prescription drug that you think you should be able to get or that you already got. You also can appeal to pay less than you originally were requested to pay.

If your appeal is denied or if you have other frustrations with your plan, you can switch Medicare Advantage plans during the Open Enrollment Period which is October 15 – December 7 every year.

What Is the Difference Between Medicare Part C And Part D?

Medicare Part C provides more coverage for everyday healthcare including prescription drug coverage with some plans when combined with Part D. A Medicare Advantage prescription drug (MAPD) plan is when a Part C and Part D plan are combined.

Medicare Part D only covers prescription drugs. If you have Original Medicare and just need a plan for prescription medications, Medicare Part D is the best choice. When you require more coverage for dental, vision, or prescription drugs, Medicare Part C plans to provide more options to fit your healthcare needs.

Should I Enroll in a Medicare Advantage Plan?

Review your coverage needs when you apply for Medicare. If Original Medicare isn’t enough, you may want to consider Medicare Part C — just know all the pros and cons.