How Much is Medicare Part C: Understanding the Average Cost in 2023

Medicare Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by private insurance companies. Part C plans provide all of the coverage of Original Medicare (Part A and Part B) along with additional benefits like prescription drug coverage and routine vision, hearing, and dental care. With Medicare Part C, everything is covered in one convenient plan.

As we head into 2023, many seniors are interested in learning more about the costs associated with Medicare Part C. Understanding the average premiums, deductibles, and other out-of-pocket expenses can help you estimate what your total costs may be if you enroll in a Medicare Advantage Plan. In this comprehensive guide, we’ll break down the average costs of Medicare Part C coverage so you can determine if it’s the right option for your healthcare needs.

What is Medicare Part C?

Medicare Part C, also known as Medicare Advantage, allows private insurance companies to provide Medicare benefits through Medicare-approved plans like HMOs and PPOs. These plans must cover everything that Original Medicare covers, but they can do so with different costs, rules, and restrictions. The key distinguishing factors of Part C plans include:

• Incorporated Part A and Part B Coverage – Rather than having separate Part A hospital insurance and Part B medical insurance, everything is bundled together under one plan.
• Extra Benefits – Most plans include additional benefits not covered by Original Medicare like vision, dental, hearing, prescription drugs, and more.
• Network Restrictions – Many Part C plans restrict you to a network of doctors and hospitals. Out-of-network care is typically not covered.
• Costs Vary – Part C plans can have different premiums, copays, coinsurance, and deductibles. Costs depend on the plan.
• Managed Care – HMOs and PPOs use utilization management tools to control costs. You may need referrals to see specialists.

Now that you understand the basics of Medicare Part C, let’s take a look at the average costs and what you can expect to pay if you enroll in 2023.

Average Cost of Medicare Part C Monthly Premiums

The first major cost of Medicare Part C is the monthly premium. Just like other health insurance plans, Medicare Advantage Plans charge a base premium to maintain coverage each month.

According to Medicare.gov, the average monthly premium for Medicare Advantage Plans in 2023 is projected to be around $18. This is actually $1 lower than the average premium in 2022.

Premium costs can vary significantly depending on the plan, coverage, and insurance provider. Here’s an overview of monthly premium costs for Medicare Part C:

• National Average – $18 per month
• Zero Premium Plans – Some plans don’t charge any premium.
• HMO Premiums – Average around $12 per month.
• PPO Premiums – Tend to be higher, averaging $26 per month.
• Enhanced Benefits – Plans with extra coverage tend to have premiums closer to $100 per month.

As you can see, Medicare Part C premiums can range from $0 to over $100 depending on the plan options you choose. Always compare premium costs as you evaluate Medicare Advantage Plans for 2023.

Medicare Advantage Deductibles

With Original Medicare, both Part A and Part B come with annual deductibles you must pay out-of-pocket before coverage kicks in. For 2023, the Medicare Part A deductible is $1,600 per benefit period and the Part B deductible is $226 per year.

Medicare Advantage Plans may also charge deductibles, but they tend to be much lower than Original Medicare. According to a report from Kaiser Family Foundation, the average deductible for Medicare Advantage Plans in 2022 was just $285. Many plans don’t charge any deductible at all.

When shopping for plans, pay attention to the deductible amount. Plans with $0 deductibles will have lower out-of-pocket costs overall. However, plans with high deductibles are available if you want to pay less in premiums each month.

Average Out-of-Pocket Spending

In addition to premiums and deductibles, your total costs for Medicare Part C include any copays or coinsurance you pay throughout the year. These out-of-pocket costs vary significantly by plan.

According to Medicare.gov, the average out-of-pocket spending per year for Medicare Advantage enrollees in 2022 was $5,519. However, actual costs can range from $0 to over $10,000 depending on the plan’s cost-sharing structure.

Plans with higher premiums often have lower copays and maximum out-of-pocket limits. Plans with $0 premiums tend to have higher copays and coinsurance. Carefully read the plan’s Evidence of Coverage document to estimate your total out-of-pocket costs for the year before Medicare enrollment.

Drug Coverage Costs

One of the biggest perks of Medicare Part C is that most plans include prescription drug coverage. This is known as Medicare Part D Plan. On average, you’ll pay the following Part D costs covered by Medicare Advantage Prescription Drug plan:

• Monthly premium – Average of $7 per month
• Deductible – Majority of plans have $0 deductible
• Copays or coinsurance – Average from $0 to $12 for generic and $35 to $44 for brand name drugs
• Catastrophic coverage – You pay no more than 5% of drug costs after hitting $7,400 in total spending

Keep in mind that costs for prescription drug coverage can also vary quite a bit depending on which Medicare Part C plan you select. Always check Part D costs when evaluating plans.

Additional Benefits

One appealing aspect of Medicare Advantage is that many plans offer additional benefits not covered by Original Medicare. Some examples include:

• Vision care
• Dental care
• Hearing exams and hearing aids
• Gym memberships
• Transportation
• Meal delivery
• In-home support services

Plans that include these extra benefits may come with higher monthly premiums. Make sure to look closely at the plan details to see which additional benefits are included and how much they will cost you throughout the year.

How Plan Costs Are Determined

As you can see, Medicare Part C costs can vary quite a bit depending on the plan. So how exactly are the costs for each Medicare Advantage Plan determined? There are a few key factors:

• Base Medicare reimbursement rates – CMS provides a set amount to plans per enrollee based on average Medicare spending. This influences the overall costs that can be covered.
• Location – Plans in high-cost areas receive greater reimbursements, allowing for more robust coverage. Rural county plans often have fewer extras.
• Plan efficiency – Plans that operate efficiently and control healthcare spending can afford to offer enhanced benefits without charging more in premiums.
• Supplemental benefits – Plans with extra benefits need to charge members more to cover those expenses. Higher premiums allow plans to offer more.
• Administrative costs – The insurer’s operating expenses and profit margin also impact overall pricing for consumers. More efficient insurers can minimize premium costs.

By law, Medicare Advantage Plans must provide coverage that is actuarially equivalent to Original Medicare. But plans have flexibility in setting specific copays, deductibles, and premiums based on their unique circumstances. Understanding what goes into the costs can help you evaluate potential plans.

Enrolling in Medicare Part C for 2023

Medicare’s open enrollment period for 2023 runs from October 15 to December 7, 2022. During this time, you can join a Medicare Advantage Plan or switch your coverage. Plan costs and benefits can change from one year to the next, so it pays to review your options.

Here are some tips as you look at Medicare Part C plans for 2023:

• Compare premiums, deductibles, drug costs, and maximum out-of-pockets between plans.
• Look up total star ratings for each plan based on quality and performance.
• Confirm your doctors are in-network before enrolling in a new HMO or PPO.
• Take advantage of free counseling through your State Health Insurance Assistance Program.
• Call plans directly if you need help estimating next year’s total costs.

The average cost of Medicare Part C in 2023 is expected to be around $18 per month for premiums. But your total costs for deductibles, copays, and coinsurance will depend entirely on the plan you select. Weigh these costs against the extra benefits and convenience of bundled Original Medicare and Part D coverage. With a little research, you can find affordable Medicare Advantage Plans that fit your healthcare and financial needs.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Senior Health Advocates a Call at (386) 222-3030. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.

FAQS

What is Medicare Part C?

A: Medicare Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by private insurance companies. It provides all of the benefits of Original Medicare (Part A and B) and often includes additional benefits such as prescription drug coverage, dental care, and vision care.

How much does Medicare Part C cost?

The cost of Medicare Plan Part C, or Medicare Advantage, can vary depending on the specific plan you choose. Most plans require you to continue pay for Medicare Part B premium, in addition to any premium charged by the Medicare Advantage Plan.

Does Medicare Part C cover prescription drugs?

Many Medicare Advantage Plans include prescription drug coverage, also known as Medicare Part D. However, not all plans offer this coverage, so it is important to review the plan details to determine if prescription drugs are included.

Can I still use my Original Medicare benefits with Medicare Part C?

No, when you enroll in a Medicare Part C plan, you will receive all of your Medicare benefits through that plan. You will no longer use your Original Medicare benefits, but you are still required to pay your Part B premium.

How do I choose a Medicare Advantage Plan?

When choosing a Medicare Advantage Plan, it is important to consider factors such as the plan’s cost, the doctors and medical providers included in the plan’s network, and the additional benefits offered. You can compare plans in your area using the Medicare website or seek assistance from a licensed insurance agent.

What is Average Medicare cost Part C?

The average cost of Medicare Part C, or Medicare Advantage, can vary depending on the specific plan and location. In 2023, the average monthly premium for Medicare Advantage Plans is expected to be around [[average Medicare Part C]] per month.

What does the Medicare Part C Plan in 2023 Cover?

Medicare Part C, or Medicare Advantage, provides all of the benefits of Original Medicare (Part A and Part B) and often includes additional benefits such as prescription drug coverage, dental care, vision care, and other services not covered by Original Medicare.

Can I have Medicare Part C and a Medicare Supplement Plan?

No, you cannot have both Medicare Part C and a Medicare Supplement Plan at the same time. Medicare Supplement Plans are designed to work with Original Medicare, not Medicare Advantage Plans.

How do I enroll in Medicare Part C?

To enroll in a Medicare Part C plan, you must be eligible for Medicare and live in the plan’s service area. You can enroll during your Initial Enrollment Period (IEP) when you first become eligible for Medicare, or during the Annual Enrollment Period (AEP) which occurs each year from October 15th to December 7th.

What is the difference between Medicare Part C and Original Medicare?

The main difference between Medicare Part C (Medicare Advantage) and Original Medicare is that Medicare Advantage Plans are offered by private insurance companies, while Original Medicare is provided by the federal government. Medicare Advantage Plans often include additional benefits and may have different costs and provider networks than Original Medicare.