What Does Medicare part C Cover?

Medicare Made Simple

What is Medicare Part C

 

Medicare Part C is another name for Medicare Advantage. Medicare Part C is administered by private insurance companies contracted with Medicare. Medicare Part C covers everything that Original Medicare (Part A and Part B) cover and may cover extra benefits as well.

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 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 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 including 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 to 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.

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