Medicare Part C: What It Covers, What It Costs
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Medicare Part C is just another name for Medicare Advantage, which is a bundled alternative to Original Medicare — meaning it includes Medicare Part A (hospital coverage), Medicare Part B (medical insurance) and usually Medicare Part D (drug coverage).
Medicare Part C plans are offered by private companies that have been approved by Medicare. Most plans provide benefits that aren’t covered under Original Medicare, and some plans also offer benefits tailored to certain chronic conditions.
What Medicare Part C covers
Medicare Part C plans offer all the benefits of Medicare Part A and Part B, with a few exceptions:
Clinical trials (Original Medicare would cover some of these costs).
Hospice services (Original Medicare helps with the cost of hospice).
Some new Medicare benefits, which temporarily are covered by Original Medicare.
Most Medicare Advantage plans include Medicare Part D prescription drug coverage. And the majority offer additional benefits that Original Medicare doesn’t offer, such as cost help with dental and vision care, fitness benefits, transportation to doctor visits and over-the-counter drug allowances.
Medicare Part C isn’t required to cover services that aren’t deemed medically necessary under Medicare.
What Medicare Part C costs
Out-of-pocket costs vary for Medicare Part C, but will typically include the following expenses:
A monthly premium: A large percentage of Medicare Advantage plans charge a $0 premium, but not all of them do.
Medicare Part B premium: You’ll still be responsible for paying your Part B premium, which is $164.90 per month in 2023. But some Medicare Part C plans pay part or all of your Part B premium as a benefit of the plan.
Copays and coinsurance: Different plans charge different amounts each time you see a medical provider, in or out of network.
Deductible: The deductible is the amount of eligible medical costs you must pay out of pocket before your plan starts paying for care.
Advantages of Medicare Part C
Instead of having Medicare Parts A, B and D, all coverage is bundled into one plan.
There are typically extra benefits available, such as cost help with dental, vision and hearing care.
Your out-of-pocket costs could be lower than with Original Medicare.
You still receive all the rights and protections of Medicare.
Disadvantages of Medicare Part C
Your list of in-network health care providers will be smaller than with Original Medicare.
You may have to get referrals or authorizations for some services, depending on your plan type.
Your plan may not cover you if you travel outside your service area.
You may not be able to get a Medigap plan if you return to Original Medicare, or it may cost more.
Types of Medicare Part C plans
Medicare Part C comes in several types, much like non-Medicare health insurance, with different requirements for finding care providers. In a health maintenance organization, or HMO plan, for instance, you need to see in-network health care providers unless it’s an emergency, and you need a referral to see a specialist. In a preferred provider organization, or PPO plan, you can see both in-network and out-of-network health care providers, although you typically pay more to go out of network.
Types of Medicare Advantage plans include:
Private fee-for-service, or PFFS plans.
Special needs plans, or SNPs.
Medical savings account, or MSA plans.
Signing up for Medicare Part C
You can sign up for a Medicare Advantage (Part C) plan at the following times:
During your initial enrollment period, which usually falls around your 65th birthday unless you qualify due to other circumstances, such as having a disability.
During each year’s fall Medicare open enrollment period, Oct. 15 to Dec. 7.
Between Jan. 1 and March 31 (the general enrollment period) if you have Part A coverage and you get Part B for the first time.
During a special enrollment period if you qualify due to certain circumstances, such as losing your current coverage.
To sign up for a Medicare Part C plan, you must have Original Medicare Part A and Part B coverage. Use Medicare’s plan finding tool to find and compare plans in your area.
Companies offering Medicare Part C must follow certain regulations set by federal and state law, but out-of-pocket costs and rules for accessing services may differ from plan to plan, and companies can change those aspects from year to year. Compare each plan’s rules, benefits and costs before choosing one that’s right for you.
If you're already enrolled in a Medicare Advantage plan, you can switch plans during the fall open enrollment period or during the Medicare Advantage open enrollment period from Jan. 1 to March 31.
Medicare Advantage providers
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
The parts of Medicare
Read more about the different parts of Medicare and what they cover.