How Does Medicare Part C Coverage Work?

Medicare Part C, better known as Medicare Advantage, is an all-in-one alternative to Original Medicare offered by private insurers approved by Medicare. A Part C plan bundles your Part A and Part B coverage into a single plan, and most plans add prescription drug coverage plus extra benefits. Here is how the coverage works and how to decide if it fits you.

What Medicare Part C covers

Every Medicare Advantage plan must cover everything Original Medicare covers. That includes Part A hospital care, such as inpatient stays, and Part B medical care, such as doctor visits, lab tests, and durable medical equipment.

Most plans go further and bundle extra benefits that Original Medicare does not include. Depending on the plan, these can be:

• Prescription drug coverage (Part D)
• Dental, vision, and hearing
• Gym memberships and wellness programs
• Over-the-counter and other supplemental allowances

How Medicare Part C works

When you join a Medicare Advantage plan, you keep paying your monthly Part B premium to the government, plus any premium the plan charges. Many plans have a $0 monthly premium, but you still share costs through deductibles, copays, and coinsurance.

One important advantage over Original Medicare: every Part C plan caps your annual out-of-pocket costs. Original Medicare has no such limit. Most plans also use a provider network, so where you get care affects what you pay.

Types of Medicare Part C plans

There are four main types of Medicare Advantage plans:

• HMO: Use providers in the plan network and choose a primary care doctor. You usually need a referral to see a specialist.
• PPO: See any provider, though in-network care costs less. No referral needed.
• PFFS: See any Medicare provider that accepts the plan's payment terms.
• SNP: Special Needs Plans are built for people with a specific condition, such as diabetes or chronic heart failure, or who also have Medicaid.

How to join a Medicare Part C plan

You must be enrolled in both Medicare Part A and Part B and live in the plan's service area. You can join during your Initial Enrollment Period when you first qualify, during the Annual Enrollment Period (October 15 to December 7), or during the Medicare Advantage Open Enrollment Period (January 1 to March 31).

Keep in mind that you cannot pair a Part C plan with a Medicare Supplement (Medigap) policy. In most cases you also cannot add a stand-alone Part D drug plan, so choose a Part C plan that already includes drug coverage if you need it.

Frequently asked questions

What is Medicare Part C?

Medicare Part C, or Medicare Advantage, is a private plan approved by Medicare that combines your Part A and Part B coverage. Most plans also include Part D drug coverage and extra benefits like dental, vision, and hearing.

How much does Medicare Part C cost?

You keep paying your Part B premium plus any plan premium, and many plans charge $0 per month. You also pay copays, coinsurance, and deductibles up to the plan's annual out-of-pocket maximum, which Original Medicare does not have.

How do I enroll in a Medicare Part C plan?

You need Medicare Parts A and B and must live in the plan's service area. You can enroll during your Initial Enrollment Period, the Annual Enrollment Period from October 15 to December 7, or the Medicare Advantage Open Enrollment Period from January 1 to March 31.

Talk to a licensed Medicare advocate

Choosing between Original Medicare and a Part C plan comes down to your doctors, your medications, and your budget. A licensed Medicare advocate can compare the plans in your area with you at no cost, with no pressure to enroll.