Medicare Part C, also known as Medicare Advantage, is a type of Medicare Plan that offers all the benefits of Original Medicare (Part A and Part B) plus additional benefits such as vision, dental, and prescription drug coverage. Medicare Part C plans are offered by private insurance companies that contract with Medicare to provide health care services to Medicare beneficiaries. Medicare Part C plans may have different costs, benefits, and rules than Original Medicare.
In this blog post, we will explain what is the average cost of Medicare Part C in 2023 and what factors affect the cost of a Medicare Part C plan. We will also compare the cost of Medicare Part C with the cost of Original Medicare and other types of Medicare Plans. Finally, we will provide some tips on how to choose a Medicare Part C plan that suits your needs and budget.
Premium
The premium is the amount of money you pay each month to have a Medicare Part C plan. The premium may vary depending on the plan you choose, your income, and other factors. Some Medicare Part C plans may have a $0 premium, which means you do not have to pay anything extra to have the plan. However, you still have to pay your Part B premium to stay in a Medicare Part C plan. The standard Part B premium for 2023 is $164.90 per month, but it may be higher or lower depending on your income and other factors.
According to the Centers for Medicare & Medicaid Services (CMS), the average premium for a Medicare Part C plan with prescription drug coverage is $28 per month in 2023¹. This is a decrease of 15% from the average premium of $33 per month in 2022¹. However, this is only an average and does not reflect the actual cost of any specific plan. Some plans may have higher or lower premiums than the average.
Deductible
The deductible is the amount of money you have to pay out-of-pocket for your health care services before your Medicare Part C plan starts to pay. The deductible may vary depending on the plan you choose and the type of service you receive. Some plans may have a $0 deductible, which means you do not have to pay anything before your plan pays. Other plans may have separate deductibles for medical services and prescription drugs.
According to CMS, the average deductible for a Medicare Part C plan with prescription drug coverage is $203 per year in 2023². This is a decrease of 25% from the average deductible of $271 per year in 2022². However, this is only an average and does not reflect the actual cost of any specific plan. Some plans may have higher or lower deductibles than the average.
Copayment and Coinsurance
The copayment and coinsurance are the amounts of money you have to pay each time you get a covered service from your Medicare Part C plan. The copayment is a fixed amount, such as $20 for a doctor visit or $10 for a prescription drug. The coinsurance is a percentage of the cost, such as 20% for a lab test or 30% for durable medical equipment. The copayment and coinsurance may vary depending on the plan you choose, the type of service you receive, and the provider you see.
According to CMS, the average copayment for a primary care visit in a Medicare Part C plan with prescription drug coverage is $9 in 2023³. This is a decrease of 18% from the average copayment of $11 in 2022³. The average copayment for a specialist visit is $22 in 2023³, which is a decrease of 12% from the average copayment of $25 in 2022³. However, these are only averages and do not reflect the actual cost of any specific plan. Some plans may have higher or lower copayments than the average.
According to CMS, the average coinsurance for durable medical equipment in a Medicare Part C plan with prescription drug coverage is 17% in 2023. This is a decrease of 6% from the average coinsurance of 18% in 2022. However, this is only an average and does not reflect the actual cost of any specific plan. Some plans may have higher or lower coinsurance than the average.
Out-of-Pocket Maximum
The out-of-pocket maximum is the most amount of money you have to pay for your health care services in a year. Once you reach your out-of-pocket maximum, your Medicare Part C plan will pay 100% of your covered costs for the rest of the year. The out-of-pocket maximum may vary depending on the plan you choose and whether you stay within your plan’s network of providers or go out-of-network.
According to CMS, the average out-of-pocket maximum for a Medicare Part C plan with prescription drug coverage is $5,992 per year in 2023. This is an increase of 2% from the average out-of-pocket maximum of $5,880 per year in 2022. However, this is only an average and does not reflect the actual cost of any specific plan. Some plans may have higher or lower out-of-pocket maximums than the average.
Medicare Part C Cost vs. Other Types of Medicare Plans
The cost of Medicare Part C may be different from the cost of Original Medicare (Part A and Part B) or other types of Medicare Plans, such as Medicare Supplement Insurance (Medigap) or Medicare Prescription Drug (Part D) plans. Here are some comparisons to help you understand the differences:
- Original Medicare vs. Medicare Part C: Original Medicare is the traditional fee-for-service program that covers inpatient care, outpatient care, lab tests, durable medical equipment, and some preventive services. Original Medicare does not cover vision, dental, or prescription drug coverage. You have to pay a Part B premium, a Part A deductible (if applicable), a Part B deductible, and coinsurance for most services. There is no limit on your out-of-pocket costs. You can see any provider that accepts Medicare. Medicare Part C is an alternative way to get your Medicare benefits through a private insurance company that contracts with Medicare. Medicare Part C covers everything that Original Medicare covers, plus additional benefits such as vision, dental, and prescription drug coverage. You have to pay a Part B premium, a Part C premium (if applicable), a Part C deductible (if applicable), and copayments or coinsurance for most services. There is a limit on your out-of-pocket costs. You may have to see providers that are in your plan’s network or pay more for out-of-network providers.
- Medigap vs. Medicare Part C: Medigap is a type of private health insurance that helps pay some of the health care costs that Original Medicare does not cover, such as deductibles, coinsurance, and copayments. Medigap does not cover vision, dental, or prescription drug coverage. You have to pay a monthly premium for Medigap in addition to your Part B premium. You can see any provider that accepts Medicare. Medicare Part C is an alternative way to get your Medicare benefits through a private insurance company that contracts with Medicare. Medicare Part C covers everything that Original Medicare covers, plus additional benefits such as vision, dental, and prescription drug coverage. You have to pay a Part B premium, a Part C premium (if applicable), a Part C deductible (if applicable), and copayments or coinsurance for most services. There is a limit on your out-of-pocket costs. You may have to see providers that are in your plan’s network or pay more for out-of-network providers.
- Part D drug plan vs. Medicare Part C: Part D is a type of private health insurance that helps pay for the cost of medications. You have to pay a monthly premium for Part D in addition to your Part B premium. You also have to pay a deductible (if applicable) and copayments or coinsurance for your drugs. There is no limit on your out-of-pocket costs for drugs. You have to use pharmacies that are in your plan’s network or pay more for out-of-network pharmacies. Medicare Part C is an alternative way to get your Medicare benefits through a private insurance company that contracts with Medicare. Medicare Part C covers everything that Original Medicare covers, plus additional benefits such as vision, dental, and prescription drug coverage. You have to pay a Part B premium, a Part C premium (if applicable), a Part C deductible (if applicable), and copayments or coinsurance for most services. There is a limit on your out-of-pocket costs for both medical and drug services. You may have to use providers and pharmacies that are in your plan’s network or pay more for out-of-network providers and pharmacies.
How to Choose a Medicare Advantage Plan in 2023
Choosing a Medicare Part C plan can be challenging because there are many factors to consider, such as:
- The cost of the plan, including premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums
- The benefits of the plan, including vision, dental, and prescription drug coverage
- The quality of the plan, including customer service, ratings, reviews, and complaints
- The network of the plan, including providers and pharmacies
- The availability of the plan in your area.
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FAQs
How much does the average Medicare Part C plan cost per month in 2023?
The average monthly premium for Medicare Part C, also known as Medicare Advantage Plans, is around $20-$50 per month in 2023, though plan premiums can vary significantly based on the specific plan you choose.
What is covered by Medicare Part A and Part B?
Original Medicare, which consists of Part A and Part B, covers many essential health care services but not all medical expenses or health care needs. Part A covers inpatient hospital stays, skilled nursing facilities, hospice and some home health care. Part B covers certain doctors’ services, outpatient care, medical supplies and preventive services.
What is the difference between Medicare Advantage Plans and Original Medicare?
Medicare Advantage Plans, also called Part C plans, are offered by private companies approved by Medicare. They provide all of your Part A and Part B coverage, and some plans provide prescription drug coverage (Part D). Original Medicare is the traditional Medicare Plan offered directly through the federal government, which consists of Part A and Part B.
Can Medicare Advantage Plans have higher costs than Original Medicare?
While many Medicare Advantage Plans have $0 premiums, some do charge monthly premiums in addition to Part B premiums, so plan costs can potentially be higher than Original Medicare depending on the services utilized. It’s important to compare specific plan costs and coverage to determine the best plan for your needs.
What is Medicare Part B and how much is the monthly premium in 2023?
Medicare Part B is medical insurance that covers certain doctors’ services, outpatient care, and preventive services. The standard monthly premium for Part B in 2023 is $164.90, though some beneficiaries pay higher amounts depending on their income. This premium is usually deducted from social security checks. So you have to compare plans first.
When is the enrollment period to join a Medicare Advantage Plan?
The Medicare enrollment period occurs annually from January 1 through March 31. During this time, beneficiaries can join, switch or drop a Medicare Advantage Plan. The general enrollment period for Original Medicare is October 15 through December 7 each year, for coverage starting the following January.
How can you get help paying for your Medicare costs?
There are programs available to help lower-income beneficiaries pay for Medicare costs. The Medicare Savings Program pays Medicare Part B premiums for some beneficiaries. Medicaid also picks up Medicare costs for those who are eligible. Beneficiaries should check if they qualify for any Medicare Savings programs to help pay for Medicare costs.
What types of plans are available under Medicare Part C?
Medicare Part C, also known as Medicare Advantage, allows beneficiaries to get their Medicare benefits through private insurance plans approved by Medicare, such as HMOs, PPOs, PFFS plans and SNPs. These plans are required to cover all benefits of Part A and B, and many offer extra benefits and services as well as prescription drug coverage through Part D.
Is there a deductible for Medicare Part B services?
Yes, there is a deductible for Medicare Part B medical insurance. The 2023 deductible amount is $226. This means beneficiaries must pay this amount out-of-pocket for Medigap services each year before Medicare Part B pays its share. The deductible does not apply to preventive care covered under Part B.