Friday, December 2, 2022

What Does Plan C Cover In Medicare

Don't Miss

Learn About Medicare Supplement Plans Available Where You Live

People Who Win With Money Are People Who Have a PLAN! #shorts

TTY 711, 24/7

1 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.

2 Fisher, Miles. Your blood could be worth a lot. You should give it away for free. . Chicago Tribune. Retrieved from

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports: is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.

Medicare has neither reviewed nor endorsed this information.

Medicare Advantage Special Enrollment For 5

You can switch to a 5-star Medicare Advantage plan or other supplemental plan offered by a private health insurance company during a Special Enrollment Period from November 30 to December 8 each year. Many plans are rated just under 5 stars but still offer great benefits and have excellent customer satisfaction.

Plans should also be compared based on their customer satisfaction and reviews. You can read reviews and compare plans based on customer service, pricing, benefits, extra services and ease of use.

How Much Does A Medicare Part C Plan Cost

As usual, Medicare plan costs can vary person to person. However, if you are feeling as though a Medicare Advantage plan is right for you, you should thoroughly consider your financial position. Advantage plans tend to be a great option for Medicare-eligible individuals who are looking to save money each month, but tend to have lower coverage needs. Typically with any health insurance plan, the lower the premium, the higher the deductible. Since an Advantage plan would entail a $0 premium, you could be paying more, especially factoring in aspects like prescription costs.Members with continuing curiosity about what they could pay with an Advantage plan are also encouraged to utilize our Cost Estimator tool.

Also Check: How Many Medicare Plans Are There

What Does Medicare Supplement Plan C Cost

The average premium cost for Medicare Supplement Insurance Plan C in 2018 was $189.88 per month.1

Its important to note that Medigap plan costs may vary based on factors such as age, gender, your health, how your insurance carrier rates its plans and where you live.

Medigap Plan C costs may also vary based on when you enroll.

The average cost listed above includes Medigap Plan C options that may offer lower premiums than what is listed, as well as some plans with higher premium costs.

Medicare Plans In Illinois

Does Medicare Cover Home Health Care

Know your options for Medicare plans in Illinois, whether youre looking for Original Medicare or Medicare Advantage.

  • VII.

Illinois has more than 2.2 million people enrolled in Medicare and the number of plan options is also growing. Comparing the different plans is key to finding the best plan for you.

  • Original Medicare
  • Medicare Advantage
  • Medicare Part D

You may also elect to add a Medicare Supplement Plan to go along with Original Medicare to help with additional out-of-pocket expenses.

Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.

  • Average costs of Medicare in Illinois: In 2022, Medicare Advantage premiums decreased 8.68% from $14.05 to $12.83. The lowest Part D plan in Illinois is $6.90.
  • Average expenditure per enrollee: In Illinois, the average Medicare spending per enrollee is $10,763.
  • Number of enrollees in Illinois: As of 2022, 2,284,894 individuals enrolled in Medicare are in the state of Illinois. Approximately 600,000 individuals are on a Medicare Advantage Plan.
  • Medicare Advantage availability: Illinois has had a 14.50% increase in Medicare Advantage Plans since 2021. There are 166 Illinois Medicare Advantage Plans available in 2022, which is an increase from 145 plans in 2021.

Read Also: Is Medicaid Or Medicare For The Elderly

Medicare Part C Eligibility

Who is eligible for Medicare Part C? Any Medicare beneficiary, regardless of age, can purchase a plan if they meet these criteria:

  • You must be enrolled in both Medicare Part A and B. Many people mistakenly think they can drop Part B if they enroll in a Medicare Part C plan. This is NOT the case. If you drop Part B, you will immediately be kicked out of your Part C plan.
  • You need to live in the plans service area. This Medicare Part C eligibility will be based on the address that you have on file with Social Security. You must choose a plan that operates in that same county. Some plans will be specific to only one or two counties, while others might span the whole state.

Be sure to also remember that Medicare Advantage plans have election periods. This means that you can enroll during your Initial Enrollment Period or during the Annual Election Period in the fall. There are also certain Special Election Periods in certain circumstances, such as if you move out of state and lose your plan. You would then be granted a SEP to enroll in a plan mid-year in your new state.

What Should I Do If My Medicare Part C Plan Doesnt 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.

Do you want to begin looking for Medicare Advantage plans in your area? Just enter your zip code on this page.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

Find Plans in your area instantly!

Recommended Reading: Does Medicare Cover Insulin Pens

Online Access To Your Plan gives you 1-stop access to your coverage, claims, ID cards, providers, and more. Log in to manage your plan or sign up for online access today.

Accidental injury, critical illness, and hospital care.

Controlling costs, improving employee health, and personalized service are just a few of the ways we can help your organization thrive.

Use Cigna for Brokers to access everything you need to manage your business and complete enrollments.

What Is Medicare Part C Coverage For Inpatient Care

What Does Medicare Supplement Plan C Cover? Medigap Plan C

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 also covers:

  • Home health care

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

Also Check: Do I Have To Have Medicare When I Turn 65

How Much Does Medicare Cost In Illinois

  • Original Medicare: Part A premiums can range from $0 to $499 per month. The Medicare Part A hospital deductible is $1,556 for each benefit period. Part B, most people pay the standard premium of $170.10 per month. The deductible for Part B is $233.
  • Medicare Advantage Plans: The average cost of a Illinois Medicare Advantage Plan is $12.83 in 2022. Some plans start as low as a zero premium.
  • Part D plans: The lowest monthly premium starts at $6.90.
  • Medigap plans: Plan G cost for a nonsmoking female age 65 in Springfield is $96 to $349.

What Does Medigap Plan C Cover

Like all Medigap plans, Plan C basic benefits are the same in most stateshowever, some plans may choose to offer extra benefits at an additional cost. At its most basic level, this plan specifically covers the following costs and benefits:

  • Medicare Part A deductible
  • Part A hospital and coinsurance costs
  • Part A hospice care copayment or coinsurance
  • Skilled Nursing Facility coinsurance

Recommended Reading: How Do I Apply For Medicare In Ohio

C Prescription Drug Coverage

Not all Medicare Advantage plans include prescription drug coverage. If yours doesnt, youll be able to enroll in a stand-alone Part D prescription drug plan.

If an Advantage plan does include prescription drug coverage, you will need to review the drug formulary. This is a list of all the medications covered by the plan and which tier they are categorized into. Drugs in lower tiers will cost less than those in higher tiers .

Medicare Part B Coinsurance Or Copayment

What Does Medicare Cover for Long Term Care

Medicare Part B helps cover costs for things like doctors appointments, medical devices and preventive care.

After you meet your Medicare Part B deductible , you are typically responsible for a coinsurance or copay of 20 percent of the Medicare-approved amount for covered services.For example, if you suffer a foot injury and need to use a wheelchair, Part B will help cover 80 percent of the cost of your wheelchair . For illustration purposes, if it costs $800 to buy the wheelchair and Medicare Part B covers it as durable medical equipment , your Part B coinsurance cost would be $160.

Medigap Plan C would fully cover your $160 Part B coinsurance.

Read Also: What Is Uhc Medicare Advantage

How Do You Sign Up For Medicare Part C

You can sign up or change your Medicare Part C plan during one of the Medicare enrollment periods.

For most people, initial enrollment in Medicare happens around your 65th birthday, starting three months before your birthday month and ending three months after your birthday month.

  • through the Social Security Administration to get your Medicare card with a unique Medicare number.
  • Compare available plans to find the option thats best for you.
  • Enroll in the Medicare Part C plan through a portal like or directly through the insurance company.
  • Because plan availability and benefits change each year, we recommend reviewing your coverage during the annual open enrollment period. This can help you make sure youre continuing to get the best deal on the level of coverage you need.

    How To Apply For Medicare Part C

    First, enroll in Original Medicare . You cannot enroll in Medicare Part C until you do this. If youâre on federal retirement benefits, meaning you have paid Medicare tax through your payroll taxes for at least 10 years, youâre automatically enrolled in Medicare on the first day of the month you turn 65. Youâre also automatically enrolled once youâve been receiving federal disability payments for 24 months regardless of your age.

    If youâre 65, but not receiving federal retirement benefits, you have to enroll for Medicare by visiting your local Social Security office, calling 1-800-772-1213, or filling out an online application through the Social Security Administration website at

    Once youâre enrolled in Original Medicare, then you can shop for a Medicare Advantage plan. You can search for plans on the Medicare website and purchase the one you want directly from the insurer.

    However, you can only enroll within a designated time period each year. New Medicare recipients have seven months to buy coverage, starting three months before the month you turn 65. This is your initial enrollment period. Outside of initial enrollment, these are the times you can purchase or make changes to a Medicare Advantage plan:

    Learn more about how to apply for Medicare.

    Also Check: How Do I Find Medicare Number

    What Is The Difference Between Medigap Plan C And Plan F

    Medigap Plan F is the most comprehensive Medicare Supplement plan on the market today. It covers everything that Plan C includes, plus one more benefit: Part B excess charges. If you have Original Medicare, and the amount a health care provider is legally allowed to charge is greater than the Medicare-approved amount, the difference is called an excess charge. With Plan F, excess charges will be taken care of, while with Plan C they become the beneficiarys responsibility.

    Learn more about upcoming changes to Medigap Plan C and F.

    What’s The Average Cost Of Medicare Part C

    What Does Medicare Supplement Plan K Cover? Medigap Plan K

    For 2022, the average cost of a Medicare Part C plan with prescription drug coverage is $33 per month.

    There’s a wide range of plan costs. Many enrollees choose low-cost or free plans, and $0 Medicare Part C plans are available in 49 states. On the high end, some plans can cost several hundred dollars per month. Expensive plans usually provide better benefits such as a broader network of medical providers, more coverage for specialized care or better cost-sharing benefits.

    An HMO plan is generally cheaper than a PPO plan. A Medicare Part C HMO plan costs about $23 per month, while local PPO plans average $43 per month. The most expensive plans are Regional PPO plans, which average $80 per month, and Private Fee-for-Service plans, which average $77 per month.

    Medicare Part C plan type

    # of plans offered

    Medicare Part C enrollees also pay for Original Medicare

    Even though Medicare Part C unifies your coverage and benefits, your monthly costs are managed separately. This means Medicare Part C enrollees will pay for Original Medicare as well as the cost of a Medicare Part C plan.

    • Medicare Part A: Usually free
    • Medicare Part B: $170.10 per month deducted from Social Security
    • Medicare Part C: $33 average cost paid to insurance company

    Cost of Medicare Part A

    Most people get Medicare Part A for free because theyve been in the workforce for at least 10 years and paid Medicare taxes as a payroll deduction.

    Cost of Medicare Part B

    Yes, you can get $0 Medicare Part C plans


    Recommended Reading: Do You Automatically Get Medicare When You Turn 65

    How Much Does An Advantage Plan Cost

    A person enrolled in a Medicare Advantage plan will pay the premium to the plan provider, and they must also pay their original Medicare premiums. There is no Medicare Part A premium cost for most people, and the Medicare Part B premium in 2021 is $148.50.

    The average monthly premium for Medicare Advantage plans in 2021 may be lower than it has been in 2020, at $21.00. This is according to a CMS estimate.

    People with a Medicare Advantage plan must also pay annual deductibles, copays, and coinsurance, which will vary according to the plan provider.

    When To Enroll In Medicare Supplement Insurance Plan C

    If you sign up for a Medigap Plan C policy during your six-month Medigap Open Enrollment Period , in most cases the insurance company must accept your application and cant charge you more if youre in poor health, nor impose a waiting period even if you have a pre-existing condition*.

    Your Medigap OEP starts the month that youre both at least 65 years old and enrolled in Medicare Part B. You must live within the plans service area. If you apply for Medigap Plan C outside your Medigap OEP, the insurance company may require you to undergo medical underwriting and doesnt have to accept you as a member. However, in some situations you might have a guaranteed issue right to enroll in a Medigap plan.

    Availability and plan costs may vary. Our Medicare Supplement insurance plan finder lets you compare Medigap policies available in your area.

    *Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plans official plan documents to understand how that plan handles pre-existing conditions.

    New To Medicare?

    Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.

    Recommended Reading: Is Rocklatan Covered By Medicare

    How Flexible Are Medicare Advantage Plans

    Most private health insurance companies that offer Medicare Part C do their best to give members multiple choices when it comes to plans, but certain plans are only available in specific service areas. This means that not all plan types may be available throughout the country, especially in rural areas. In these cases, you may want to go with Original Medicare if you cant find the plan that you want. Most companies will offer different types of plans, including:

    • Medicare HMO Health Maintenance Organization
    • Medicare PPO Preferred Provider Organization
    • Medicare PFFS Pay-Fee-For-Service
    • Medicare SNP Special Needs Plans

    The most flexible of these plans is likely the PPO, which does not require you to pick a primary care provider or stay within network. In general, PPOs charge a higher fee when you go out of network and may have a higher monthly cost than an HMO. These plans do allow you to go out of network, which is beneficial if you have a chronic health condition or need to see a special doctor. If you already have a primary care doctor you like, a PPO may also be the best option.

    An HMO is not a flexible option. For one, you have to pick a primary care provider, and you cant see doctors or facilities outside of the network. You also need a referral to see a specialist. If you have to get urgent care, you need to make sure that your facility is in your network or else you will pay out of pocket.

    More articles

    Popular Articles