medicare Advantage
Part C Plans
Low-premium Medicare replacement plans.
part c for Chronic conditions
Low-premium Medicare replacement plans, designed for individuals with chronic conditions like diabetes or heart disease.
part C for Medicaid Eligibles
Zero-dollar plans with minimal cost sharing liability and extra benefits for individuals eligible for both Medicare and Medicaid.
PART C PLANS
what are medicare part c plans?
Medicare Part C plans are advertised under the term “Medicare Advantage.” These plans combine your inpatient (Part A: Hospital), outpatient (Part B: Medical), and Prescription (Part D: Drug) coverage under a single plan offered through a private health insurance company.
This means that when you see the doctor, they bill the health insurance company first - not the government.
Part c plan benefits
At a minimum, Part C “Medicare Advantage” plans must provide the same level of care offered to you under Original Medicare. Often, they go above and beyond this minimum. To attract new clients and retain old ones, health insurance companies offer extra benefits including dental, vision, hearing, and gym memberships.
Furthermore, Medicare Part C plans can save you money up-front. In many large cities, monthly premiums can be as low as $0 per month.
Similar to Medicare Supplement plans, Part C plans also limit how much you pay out of pocket for inpatient and outpatient costs each year. Currently, the highest maximum-out-of-pocket cost legally allowed for a part C plan is $6,700. But in large counties like Maricopa, the low end for this limit is around $3,000.
part c premiums and copays
Although monthly premiums for Part C plans can be as low as $0, that does not mean service is free. First, you must still pay the Part B monthly premium. For most Americans in 2020, this is $144.60 per year.
Second, with Part C plans you will pay co-pays and co-insurance for services used. These amounts vary from plan to plan and change from year to year. So it’s important to stay on top these changes and make sure that your coverage will meet your needs each year at Annual Enrollment Period (October 15th – December 7th).
why part C?
Part C is for people who are:
Generally healthy* (special plans for chronic conditions may exist – read more below)
Want to pay little to nothing up-front for health insurance
Don’t mind seeing doctors within a network
Want to limit their hospital and medical costs
Part C can also be a good option for people who don’t qualify for a Medicare Supplement plan. By enrolling in a Part C plan, they can still set a limit to how much they’ll pay for hospital and medical costs each year.
Finally, there are special Part C plans designed to meet the needs of certain groups of individuals (such as Part C Diabetes plans).
PART C PLANS FOR CHRONIC CONDITIONS
part c chronic condition health plans
People on Medicare with diabetes know how expensive things can be. Under a standard Medicare Advantage (also known as a “Part C”) Plan, specialist co-pays and essential prescriptions like insulin can really add up. Fortunately, select health insurance companies and the national government are aware of this. Together, they have created special diabetes health plans that increase the quality and affordability of health and drug coverage for you and approximately 14.3 million other American seniors.
What to look for in this type of Health Plan:
When looking into a Part C Diabetes Health Plan, always check the following:
1. Are your doctors in-network?
A good doctor can be worth their weight in gold. If you have a primary care doctor or specialist that means a lot to you, check to see if they are in-network. If so, great! But if not, ask what other doctors are, and find out how well they treat their patients.
2. Are your prescription drugs on the formulary (drug List)?
Is your brand of insulin in the special tier on the drug list? If not, what other brands are? If your brand or another that works well for you is on the list, you could save hundreds of dollars on prescriptions over the year.
3. What are the doctor co-pays?
The health insurance companies behind Diabetes Health Plans know that you may need to see the doctor more often than other people. To make treatment affordable, they generally keep primary care doctor copays very low (often as low as $0) and make specialist copays more competitive than most other plans.
4. What are the diabetes related benefits?
Diabetic supplies like glucose monitors and testing strips are typically provided to you at little to no personal cost. This also goes for procedures like diabetic eye exams and foot care. Always ask what benefits are available that address your special diabetic needs.
What Makes These Special Plans Different?
Diabetes Health Plans are a type of “Part C” Advantage Plan. Like an HMO or PPO, they use a network of doctors who work together to meet your special needs. Each doctor knows what the other is doing. They coordinate your treatment so that you can focus on living a happier, healthier life.
Just like regular Medicare Advantage Plans, Diabetes Health Plans have a formulary (drug list) with drug tiers. The cost you pay for a prescription depends on its tier. Typically, plans have 5 of them. Tier 1 drugs are the least expensive, and tier 5 drugs cost the most.
Unlike regular Medicare Advantage Plans, Diabetes Health Plans also tend to include a special drug tier. This special tier gives people with diabetes excellent prices on many of the medications that they frequently use.
Additionally, Diabetes Health Plans may have benefits that go above and beyond regular Medicare Advantage Plans. Along with things like enhanced vision coverage and foot care, these can include lower specialist co-pays and excellent transportation benefits. This makes going to the doctor easier and more affordable for you.
who can enroll, and when?
To enroll in this special type of plan, you must be diagnosed with type 1 or type 2 diabetes. Additionally, you must live within the plan’s service area, and have Medicare Parts A and B.
As with other Medicare Advantage plans you can sign up for a Diabetes Health Plan during your 7-month Initial Enrollment Period (3 months before you turn 65, the month of your 65th birthday, and 3 months after), or every year during Annual Enrollment Period (October 15th – December 7th).
However, having diabetes also qualifies you for a Special Enrollment Period which can allow you to enroll in a Diabetes Health Plan at any time during the year.