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What are the disadvantages of Medicare Part C plans?

Medicare Part C: Page 7

By , Caring.com Expert
94% helpful

Although Medicare Part C plans have both cost and coverage benefits, they also have serious drawbacks. With Medicare Part C managed care plans, the limits on which providers you can see may be the most important. If you want to consult a doctor who's not in the plan's network, you'd have to pay some or all of the cost yourself. (This is less of a problem with large managed care plans, especially in urban areas. That's because most doctors participate in the networks of the big managed care plans.)

If you're considering a Medicare Part C managed care plan, one of your first steps should be to see if your regular doctors are in the plan's network. If not, and you want to stay with your doctors, that plan isn't a good one for you.

If you're considering a Medicare Part C fee-for-service plan, ask your regular doctors if they have any experience with the plan, and if so whether they usually accept the plan's terms and payments. If not, that plan may not be right for you.

Another problem with a Medicare Part C managed care plan can arise if you want to see a specialist. If the Medicare Part C managed care plan itself decides the specialist isn't necessary, you'd have to pay for the visit out of your own pocket. Likewise, if the plan decides certain care not provided by your primary care doctor -- for example, extensive physical therapy or home healthcare -- isn't necessary, the plan won't pay for it even if a doctor prescribes it.

There might also be a problem with a Medicare Part C plan if you often spend time in more than one place -- traveling, at a second home, or staying with other family members. Coverage by a Medicare Part C plan is usually limited to the region where you live. Outside the region, you'd be responsible for some or all nonemergency bills.

Finally, there's the risk that you'll be dropped from a Medicare Part C plan. Over the past few years, many people with a Medicare Part C plan have suddenly found themselves without coverage when the plan decided to stop operations in their region. Plans regularly pull out of areas where their profits aren't making them happy. If you're dropped in this way, you aren't completely out of luck -- some other options are available -- but scrambling for other coverage can be difficult.