Is Medicare Part C available to no cost to any insurance company?

3 answers | Last updated: Sep 30, 2016
Cindy asked...

I understand that Medicare Advantage, Medicare Part C is available to no cost to any insurance company. Why don't more people do this? Is there a difference between the care you will receive with Medicare Part C?

Expert Answers

While Medicare Part C health plans, also called a Medicare Advantage plans can provide certain cost and coverage benefits, over 80% of people eligible for Medicare use traditional Medicare Part A and B instead. One of the reasons is that the cost advantages of Medicare Part C are often not as great as they first appear. Your question makes this point very well. Yes, there are a number of Medicare Part C plans that charge no monthly premium, and some services may be provided without any copayment. But that does not mean you don't have regular costs, because there are copayments you must pay for many other services you receive.

There are also other disadvantages with many Medicare Part C plans, as compared to traditional Medicare. Most Part C plans offer some sort of managed care (like an HMO), which limits the doctors and other providers you can use. To consult a doctor who's not in the plan's network, you'd have to pay most if not all of the cost yourself. Even if your regular doctors are in a Medicare Part C plan, they might not stay in the plan, or you might need to consult with other doctors in the future and your choice will be limited by the Medicare Part C plan's network.

Another problem with Medicare Part C plan can is that they often exercise tight controls over what care you can receive, rejecting some care even if your doctor prescribes or refers you for it. This problem can arise if your doctor refers you or you want to see specialist. Medicare Part C plans more often decide that specialist aren't necessary, and insist that you receive that care from your primary care doctor (which is cheaper for the Part C plan). The same problem can arise with other types of care that your doctor doesn't provide, such as physical therapy or home health care.

If you frequently spend time in more than one place -- traveling, at a second home, or staying with friends or family members -- a Medicare Part C plan might not be good for you. That's because coverage by a Medicare Part C plan is usually limited to the region where you have your primary residence. Outside your home region, you'd be responsible for some or all of your nonemergency medical bills.

Also, many people avoid Medicare Part C plans because of the risk of being dropped from coverage. In recent years, many Medicare Part C plans have suddenly decided to stop operations in particular regions where they don't think they're making a high enough profit, and drop coverage for everyone living in that region. If you're dropped in this way, finding other coverage is not always easy, and this has made many people shy away from Medicare Part C plans.

Community Answers

Kec1938 answered...

Should a medicare advantage plan cease operations you always have medicare to fall back on and most likely there will be another plan that you would be accepted into. Medicare Advantage Plans do not cease in the middle of the year. You are able to change to another plan at the beginning of each new year. I am a disabled person and have never had any problem receiving the services of a specialist. I am not certain where the author of the above article is coming from or what his motive is or his actual understanding of the program. I believe he is most likely an advocate of the Insurance Industry and not of the consumer. Copays. You have copays in regular medicare and to my knowledge they are greater than in a medicare advantage plan. If I am incorrect please advise. Frankly I would consider the above article for what it really is----a commerical against medicare advantage plans. Oh by the way I have been under United Health Care Medicare Advantage since 2003 and during the year of 2004 they paid out in my behalf an excess of $1,000,000.00. Therefore, at the present time I have the best of both worlds. ...

Cindy answered...

Wow! kec, I am so happy to get your answer. I will be 65 soon and last year was the first I ever heard of "Medicare Advantage" There are no commercials on TV for this. Everyone I know has a policy that they have to pay $100.00 or more a month for. I guess people think if it is free there must be something wrong. Thank you for answering. Good luck to you.