Medicare Part C Plans

Medicare Part C plans — also known as Medicare Advantage plans or MA Plans — are offered by government-approved private health insurers as an alternative to Original Medicare.

Jeanine Skowronski

Jeanine Skowronski

Published June 2, 2018

Medicare is the federal health insurance program primarily for Americans 65 and older. Medicare comes in four parts: A, B, C and D. Medicare Part C is a private alternative to Medicare Part A (inpatient insurance) and Medicare Part B (outpatient insurance). Here’s what you need to know about Medicare Part C.

What is Medicare Part C?

Medicare Part C plans — also known as Medicare Advantage plans or MA Plans — are offered by government-approved private health insurers as an alternative to Original Medicare.

Original Medicare is comprised of Medicare Part A and Medicare Part B. Medicare Part A is hospital (or inpatient) insurance. Medicare Part B is doctor (or outpatient) insurance. Medicare Part D, also offered through private insurers, is prescription drug insurance.

How much does Medicare Part C cost?

It depends. You have to enroll in Original Medicare to buy Medicare Part C, so right off the bat, you have to pay the Medicare Part B premium. It’s typically $134 a month, but sometimes higher, depending on income.

Beyond that, the costs of Medicare Part C vary by plan — and expenses are really all over the map. They are capped, though. Medicare limits the amount recipients pay out of pocket for inpatient and outpatient services to no more than $6,700 a year.

The average out-of-pocket limit for Medicare Advantage enrollees was $5,219 in 2017, according to the Kaiser Family Foundation. Just over half (52%) of Medicare Part C enrollees were in plans with out-of-pocket limits exceeding $5,000.

Learn more about how much Medicare costs collectively.

What does Medicare Part C cover?

Medicare Part C covers everything Original Medicare covers and (usually) then some.

Most Medicare Part C plans come with vision, dental, hearing and prescription drug coverage, none of which are covered by Original Medicare. That extra coverage is why many recipients buy a Medicare Advantage plan, even though it means paying two premiums.

Our partner Via Benefits can help you compare and buy Medicare plans, including vision and dental options, in your area.

What doesn’t Medicare Part C cover?

Medicare Part C must cover anything Original Medicare covers, but any extra coverage is optional, so you’ll have to read each plan’s explanation of benefits to know what it includes or excludes. Also, Medicare Part C does not cover hospice care. Those expenses are still covered by Original Medicare, whether you purchase an Advantage plan or not.

Who is eligible for Medicare Part C?

You can purchase a Medicare Part C plan so long as you are enrolled in Original Medicare. You must also live in a particular Advantage plan’s network to buy it.

You’re automatically eligible for Original Medicare once you turn 65. You also qualify for Medicare if you’re receiving Social Security Disability Insurance or SSDI for a period of time (usually 24 months).

Medicare Part C vs. Medicare Part D

Medicare Part C and Medicare Part D are both optional and sold through private health insurance companies approved by the federal government. But Medicare Part D plans cover only prescription drug coverage where Medicare Part C plans must cover everything Original Medicare covers (inpatient and outpatient health care expenses). They often cover expenses Original Medicare does not, including dental, vision and hearing insurance. As such, a Medicare Advantage Plan can sometimes help recipients curb total out-of-pocket health care costs. It all depends on what plans are offered in your state and what other programs are available to you.

Most Medicare Care Part C plans offer prescription drug coverage, known as Medicare Advantage Prescription Drug plans (MAPD). If you purchase a Medicaid Advantage plan, you probably don’t need Medicare Part D.

How do Medicare Advantage Plans work?

Medicare (the program) pays a certain amount of money each month to the insurers that offer Medicare Advantage Plans. The insurers must follow rules set by Medicare, which include a cap on out-of-pocket expenses and coverage of the same services as Original Medicare. Medicare Advantage plans fall into one of the following buckets:

  • Health Maintenance Organizations: HMOs allow you to only see a health care provider in your network, unless you need emergency care. They also require a physician referral before paying for you to see a specialist.
  • Preferred Provider Organizations: PPOs give you more freedom when choosing a healthcare provider or doctor. Most cover at least some of the bill at out-of-network providers, albeit at a higher price. They also let you go straight to a specialist, no referral required.
  • Private Fee-for-Service Plans: In a PFFS plan, the insurer, and not Medicare itself, decides how much you pay for care. A few have networks of participating providers, but, in most cases, you must ask if the health care provider will accept your plan’s terms before receiving non-emergency treatment.
  • Special Needs Plans: SNPs only cover people with specific diseases or characteristics, including diabetes, end-stage renal disease (ESRD), HIV/AIDS, chronic heart failure, or dementia.
  • Medical Savings Account Plans: MSAs are essentially high-deductible Medicare Advantage plans. You pay for services and medication via a savings account akin to an HSA that Medicare deposits a set amount of money in. If you spend all the money in your MSA, you have to pay expenses out-of-pocket until you hit your deductible.

Should I get a Medicare Advantage plan?

Again, that depends, largely on what plans are offered in your state. However, Medicare Advantage plans usually aren’t the best option for low-income recipients, as they qualify for other Medicare savings programs. They’re also not generally necessary if you’re still receiving employer-sponsored coverage.

The pros of Medicare Part C

  • Provides coverage for services Original Medicare does not, like vision or dental
  • Caps out-of-pocket expenses
  • Usually offers prescription drug coverage

The cons of Medicare Part C

  • Possibly must pay two premiums, one for Medicare Part B and one for your Advantage Plan
  • Networks don’t usually include as many health care providers as Original Medicare
  • Can’t be used in conjunction with employer-sponsored health care benefits that supplement Original Medicare

To find out if Medicare Part C is right for you, research what plans are available to you. Be sure to check:

  • The premium: How much does the insurer expect you to pay each month just to have the plan? Remember, you have to stay enrolled in Original Medicare to buy a Medicare Advantage plan, which means you must also pay the Part B premium.
  • The deductible: How much will you have to pay out-of-pocket before the insurer starts to cover the cost of covered health care expenses?
  • Copays/coinsurance: How much will you to chip in each time you visit a doctor, hospital or pharmacy?

Be sure to understand the full scope of Part C plan’s coverage, too. That means noting what extra insurance it affords you and what health care providers in your area are in network.

How do I apply for Medicare Part C?

First, enroll in Original Medicare. If you’re on federal retirement benefits, this happens automatically on the first day of the month you turn 65. You’re also automatically enrolled once you’ve been on federal disability for 24 months.

If you’re 65, but not receiving federal retirement benefits, you have to enroll for Medicare by visiting your local Social Security office, calling 1-800-772-1213 or filling out an application online at the Social Security Administration website.

Once you’re enrolled in Original Medicare, you can shop for a Medicare Advantage plan. New Medicare recipients have 7 months to buy coverage, starting three months before the month you turn 65. Outside of initial enrollment, you can only purchase or make changes to a Medicare Advantage plan during certain times of the year:

  1. Open enrollment for Medicare Part C and Medicare Part D, which runs from Oct. 15 to Dec. 7 each year. It’s also called the annual election period (AEP).
  2. Special enrollment, which follows a event, like moving, or a loss of coverage. It’s also known as a special election period (SEP).
  3. Medicare Advantage Disenrollment period, which is a window of time (January 1 to February 14 each year) where you can drop your Medicare Part C plan and revert back to Original Medicare.

Learn how to apply for Medicare.

How can I buy a Medicare Part C plan?

You can search for plans on the Medicare website and purchase the one you want directly from the insurer during initial, open or special enrollment.

Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.