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What is covered under Medicare Part C?

Medicare Parts A & B

Medicare Part C, also known as Medicare Advantage, offers much of the same coverage that Original Medicare does. This includes services covered by Medicare Part A, such as inpatient hospital care, inpatient nursing home care, and home health care. It also includes services covered under Medicare Part B such as doctor’s visits (both with primary care physicians and specialists), preventive tests and vaccines, lab tests, x-rays, certain medical equipment, inpatient and outpatient mental health services, and more. The only major service which is covered under Original Medicare but not offered by Medicare Part C is hospice care. Note that while Medicare Advantage Plans will cover many of the same supplies and services as Medicare Parts A and B, the costs of such supplies and services under the two types of coverage may not be the same.

Additional Services

In addition to covering almost all of the same services as Original Medicare, Medicare Part C will also cover some things which Medicare Parts A and B do not, such as routine dental, vision, and hearing care, including hearing aids. However, the word “routine” here is important – Medicare Advantage Plans typically do not cover more advanced forms of care in these categories. For example, the dental coverage offered by these plans is typically only good for cleanings, exams, and other simple procedures. Medicare Advantage Plans also frequently include coverage for health and wellness programs such as Silver Sneakers and other fitness programs. Last but certainly not least, many of these plans offer coverage for prescription medications. The exact services, supplies, and medications covered under Medicare Part C will vary from one plan to another. Thus, when considering Medicare Advantage Plans, it is important to take a close look at what each individual plan does and does not cover.

Appeals and Changes to Your Coverage

If you are denied coverage for an important service, piece of equipment, or medication which your plan should have included, you have the option of making an appeal. You may also make appeals if the prices for such items and services are unreasonably high. If you are not satisfied with your Medicare Part C coverage as a whole, you also have the opportunity to switch to a different Medicare Advantage Plan or change back to Original Medicare during the Annual Election Period, which runs from October 15th through December 7th each year. You may also change from a Medicare Advantage Plan to Original Medicare during the annual Medicare Advantage Disenrollment Period, which lasts from January 1st to February 14th. Unlike the Annual Election Period, this is the only type of change which can be made during this time.

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Who is eligible for Medicare Part C?

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