Medicare Part C
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 12/21/21
Duration: 10 Minutes
In this episode, Ben Rothering gives us information about Medicare Part C. Mr. Rothering talks about what part C covers, who offers it, and if it is necessary to have it.
Transcription:
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part four of a five-part series on Medicare. For anybody who is eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D, is Ben Rothering. He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. So Ben, welcome back to the podcast, we're in let's see this is part four, right of our five-part series. We covered enrollment in the first episode. Then we did part A in episode two, part B, last time, this time we're talking about part C.
And as you and I have discussed kind of off the air, there's every good reason to split these things up because it's just a lot of information. It's pretty dense. And we want folks to be able to benefit from your expertise and be able to make sense of all of this. So let's get into part C. What do folks need to know about Medicare part C?
Ben Rothering BS Education (Guest): So Medicare part C is known as Medicare Advantage or MA plans. Okay. And they are offered by Medicare approved private companies. That must still follow the rules that are set by Medicare. Medicare Advantage plans, a lot of them will include drug coverage within them. But not all of them. So that's definitely something that you want to look at and know what your own needs are to make sure that, you know, if that's the route you go, that's something you take a look at and get the coverage that you need.
In most cases, you will need to use healthcare providers who participate in a plan's network. So you'll have an HMO or a PPO. You'll have to stay within that network and see doctors within those networks. If you want to get a second opinion from somebody who isn't in the network, you're going to need to get permission, right? You have to get a referral in order to do that. These plans will set a limit on what you have to pay out of pocket each year for covered services. Some will offer non-emergency coverage that's outside of the network, but typically at a higher cost. So if someone has A and B, they do not need part C. Okay. So I'm going to say that again. If you have A and B you don't need C. If you decide to pick up Medicare Advantage, which is again, part C, then what happens is you are removed from parts A and B essentially, you're going to keep paying your part B premium, but now that premium is going towards this private insurance company that is now kind of taking over and now is your alternative to Medicare, so to speak.
So another thing about Medicare Advantage plans is that they are optionally renewable every year. So every year that plan needs to renew their agreement with Medicare. And if they don't, then that's something you will get a letter in the mail and you'll have to find another product to help you out or other insurance coverage to help you out.
Your out-of-pocket costs can change over time with these plans, with Medicare Advantage plans, from year to year, coverage can change. They can add and subtract coverage. Costs can go up or down. So it's definitely something that with your Advantage plan, you want to make sure that you're keeping up and you understand the coverage that you have and any changes that are being made on a year to year basis.
Host: All right. So my takeaway here, Ben is if you have A and B, parts A and B, you don't need C, right?
Ben: Correct.
Host: I'm guessing folks are going to have more questions, right. Even though we've been doing this great series for Stoughton, breaking all the parts, you know, into their own episodes for everybody, I'm sure folks will have more questions. They'll want to have a longer conversation with Ben. How can they reach you?
Ben: Absolutely. My cell phone or my email address are the best ways to get in touch with me. My cell phone number is (608) 354-3869. Or my email address is This email address is being protected from spambots. You need JavaScript enabled to view it. . That's This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: That's great. Well, we are through four parts of our series now. We're going to finish off with part five next time. We're going to talk about Medicare part D right. I don't want to be too much of a tease, but we did A, B and C. We've got part D coming up. Look forward to speaking to you then. Thanks so much, Ben. You stay well.
Ben: Thanks Scott. You as well.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Scott Webb. Stay safe and be well.
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part four of a five-part series on Medicare. For anybody who is eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D, is Ben Rothering. He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. So Ben, welcome back to the podcast, we're in let's see this is part four, right of our five-part series. We covered enrollment in the first episode. Then we did part A in episode two, part B, last time, this time we're talking about part C.
And as you and I have discussed kind of off the air, there's every good reason to split these things up because it's just a lot of information. It's pretty dense. And we want folks to be able to benefit from your expertise and be able to make sense of all of this. So let's get into part C. What do folks need to know about Medicare part C?
Ben Rothering BS Education (Guest): So Medicare part C is known as Medicare Advantage or MA plans. Okay. And they are offered by Medicare approved private companies. That must still follow the rules that are set by Medicare. Medicare Advantage plans, a lot of them will include drug coverage within them. But not all of them. So that's definitely something that you want to look at and know what your own needs are to make sure that, you know, if that's the route you go, that's something you take a look at and get the coverage that you need.
In most cases, you will need to use healthcare providers who participate in a plan's network. So you'll have an HMO or a PPO. You'll have to stay within that network and see doctors within those networks. If you want to get a second opinion from somebody who isn't in the network, you're going to need to get permission, right? You have to get a referral in order to do that. These plans will set a limit on what you have to pay out of pocket each year for covered services. Some will offer non-emergency coverage that's outside of the network, but typically at a higher cost. So if someone has A and B, they do not need part C. Okay. So I'm going to say that again. If you have A and B you don't need C. If you decide to pick up Medicare Advantage, which is again, part C, then what happens is you are removed from parts A and B essentially, you're going to keep paying your part B premium, but now that premium is going towards this private insurance company that is now kind of taking over and now is your alternative to Medicare, so to speak.
So another thing about Medicare Advantage plans is that they are optionally renewable every year. So every year that plan needs to renew their agreement with Medicare. And if they don't, then that's something you will get a letter in the mail and you'll have to find another product to help you out or other insurance coverage to help you out.
Your out-of-pocket costs can change over time with these plans, with Medicare Advantage plans, from year to year, coverage can change. They can add and subtract coverage. Costs can go up or down. So it's definitely something that with your Advantage plan, you want to make sure that you're keeping up and you understand the coverage that you have and any changes that are being made on a year to year basis.
Host: All right. So my takeaway here, Ben is if you have A and B, parts A and B, you don't need C, right?
Ben: Correct.
Host: I'm guessing folks are going to have more questions, right. Even though we've been doing this great series for Stoughton, breaking all the parts, you know, into their own episodes for everybody, I'm sure folks will have more questions. They'll want to have a longer conversation with Ben. How can they reach you?
Ben: Absolutely. My cell phone or my email address are the best ways to get in touch with me. My cell phone number is (608) 354-3869. Or my email address is This email address is being protected from spambots. You need JavaScript enabled to view it. . That's This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: That's great. Well, we are through four parts of our series now. We're going to finish off with part five next time. We're going to talk about Medicare part D right. I don't want to be too much of a tease, but we did A, B and C. We've got part D coming up. Look forward to speaking to you then. Thanks so much, Ben. You stay well.
Ben: Thanks Scott. You as well.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Scott Webb. Stay safe and be well.
