What Is Medicare Part C? | Coverage Details & (Full Guide)

A doctor and an elderly woman smiling and looking at each other.

Medicare is broken into many different parts, and those parts can sometimes be confusing. You may have heard of Medicare Part A and Medicare Part B already, but Medicare Part C and Medicare Part D are also essential pieces of the Medicare puzzle. You will commonly hear Medicare Part C referred to as a Medicare Advantage plan. So, just what is Medicare Advantage, and how does it work? We will give you all the details you need to know, including how it works, how much it costs, and how to get signed up.


What Is Medicare Part C?

So, what is a Medicare Advantage plan? Medicare Part C, or a Medicare Advantage plan, is a Medicare insurance plan that rolls all your Medicare coverage into a single policy that is easier to manage and maintain. Part C is administered and managed by private insurance companies. These insurance companies contract with Medicare to provide these policies. The plans must include at least the same level of coverage as Original Medicare. However, the companies are allowed to set their own rules beyond that. So, as long as the minimum level of coverage is met, the insurance company can set its own coverage rules.

Medicare Advantage plans also vary when it comes to cost since the companies who manage the plans can set their own rules. They get to set their own premium amounts, copays, deductibles, coinsurance amounts, and any other costs associated with the plans. Most Advantage plans include additional benefits beyond Original Medicare as well. Many of these plans include dental and vision benefits, along with prescription drug coverage (Part D plans). Some even offer benefits like free gym memberships and other things to their beneficiaries.

You should also know that Medicare Part C is not universally available, and the plans are not standardized across the country. This means that the plans available to you depend on where you live. The insurance companies who sell these plans are generally only able to offer them in specific states or regions. Therefore, you can only choose from the plans available to you when you get ready for enrollment.


Original Medicare VS Medicare Part C Plans: Coverage Differences

You definitely want to make sure that the plan you choose has the health care coverage you need. So, what is the difference in coverage when it comes to Original Medicare versus Medicare Part C? Original Medicare consists of both Medicare Part A and Medicare Part B. So, what does Original Medicare cover? Medicare Part A is considered hospital insurance and covers hospital stays, inpatient care, hospice care, and care in a skilled nursing facility. Medicare Part B is more traditional medical insurance. It covers doctor visits, lab tests, outpatient services, and preventive services. Medicare Part C must provide at least the same level of coverage provided by Original Medicare. So, at a minimum, your Part C plan must cover the things mentioned above.

Many Medicare Part C plans provide additional benefits beyond the minimum level of required coverage. While the details of each plan vary, like whether the plan is a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), most of them provide extra benefits beyond what is required. These health plans often provide dental and vision benefits, prescription drug plans, and even wellness programs. In addition to PPOs and HMOs, you will find some Advantage plans that are designated as Special Needs Plans (SNPs). These plans are limited to people with certain medical conditions or medical needs. You might also see Private Fee For Service plans (PFFs). These are plans in which the insurer has contracted with the medical providers to determine how much the plan will pay.

Since these plans are not managed by the Federal Medicare program, the types of Medicare Advantage plans available to you will depend on where you live. When looking at coverage details, you should also consider the size of the plan’s network. Some plan options include a limited number of healthcare providers, and most HMO plans require a referral before you can see a specialist. Make sure that you fully understand the plan’s details before signing up to ensure that it is the best fit for your needs.


Cost Of Medicare Advantage Plans

A piggy bank in the foreground and an elderly woman using a calculator and computer in the background.

The cost of Medicare Advantage plans varies according to several factors, like coverage details, copay amounts, and deductibles. Like traditional health insurance plans, the insurer can set their own rates. Some Medicare Advantage plans have no monthly premium, so there is no premium cost with these plans. Some plans even offer a Medicare Give Back benefit. This means that your Advantage plan provider will help cover a portion of your Medicare Part B premium. On the other end of the spectrum, some of the best Medicare Advantage plans have premium amounts that range from $50 to $200 per month.

In addition to the monthly premiums, there are also other out-of-pocket costs associated with Medicare Advantage plans. With most plans, you will be responsible for meeting an annual deductible, along with paying copays or coinsurance amounts when you receive medical services. Medicare utilizes a fee-for-service model, which means that physicians are paid according to the number of procedures they perform and not necessarily related to the quality. Many people choose to utilize a medical savings account (MSA) to help cover some of these out-of-pocket expenses.


How To Enroll In A Part C Medicare Plan

Enrollment in a Medicare Part C plan is not difficult. First, you need to be eligible for Medicare to sign up for a plan. Then, you need to find the plans available in your local service area. You can visit the Medicare plan finder tool to help you find plans available to you. You might also choose to talk to your insurance agent for assistance with finding and selecting a plan. Once you find the plan that is right for you, you will need to contact the insurance company that manages the plan to get signed up. However, you cannot sign up at any time. It is generally best to sign up during your initial enrollment period to avoid any late enrollment penalties. This period begins three months before your 65th birthday, runs through your birthday month, and ends three months after your birthday.

If you miss the initial enrollment period, you may be eligible for a special enrollment period. This often applies to individuals who are still employed and receive health care insurance through a group plan with their employer. Upon retirement, you can get signed up for coverage without the late penalty. Finally, Medicare has a Medicare Advantage open enrollment period each year, during which you can get signed up for a plan. The insurance company you select will provide you with an insurance card and all the details about your new plan.


Part C & Medigap — How They Work Together

Now that you understand Medicare Part C let’s discuss Medicare supplement plans — or Medigap. While they might sound similar, there are some big differences when comparing Medicare Advantage vs. Medigap. Medigap helps pay for out-of-pocket expenses not covered by Original Medicare. This can include items like copays, deductibles, and coinsurance amounts. It sometimes even includes additional services not covered by Medicare, like extended hospital stays once your Medicare Part A benefits are used up. These Medigap plans are administered by private insurance companies, and they require the payment of a monthly premium. There are about ten different plans from which to choose, and the plans are mostly standardized across all states.

The biggest thing to note is that Medigap plans do not work together with a Medicare Part C plan. The two types of plans are mutually exclusive. This means that you can only be enrolled in one or the other, but not both. If you opt for a Medigap plan, then you must be enrolled in Original Medicare. Similarly, if you decide to enroll in a Medicare Advantage plan, you will not be eligible for Medicare supplement insurance.


The Bottom Line

Medicare Part C provides a way for Medicare beneficiaries to lump all their Medicare coverage into a single plan. This often makes it much easier to manage your health care expenses. Many of these plans include extra benefits beyond what Original Medicare covers. They might provide coverage for dental services, vision services, hearing aids, urgent care visits, etc. The details of each plan vary since the private insurance companies who manage the plans are allowed to set their own rates and rules. However, these plans must provide at least the same level of benefit as Original Medicare provides.


Frequently Asked Questions


Is Medicare Part C required?

No, Medicare Part C is not required. If you choose not to enroll in Part C coverage, there is no penalty for not enrolling. These are optional plans that can replace your Original Medicare coverage. Some people find that these plans better meet their needs than Original Medicare coverage. However, for others, Medicare Advantage plans are not the best option. You should closely examine all your available options before ultimately selecting the plan that you will use.


What’s the difference between Medicare Part C and D?

Medicare Part D is prescription drug coverage. It provides benefits that help pay for prescription drugs and medications. Part D coverage is optional, but it can be added to your Original Medicare coverage. Part C plans combine all your Medicare coverage into a single plan and policy. Part C is also called Medicare Advantage. These plans often include Part D coverage as part of their benefits.


What are the benefits of Medicare Part C?

One of the biggest benefits of Part C coverage is that it allows you to easily manage and maintain all your Medicare coverage through a single plan. In some cases, Part C leads to lower overall health care expenses. This will depend on your personal situation. Another big benefit of Part C plans is that they often provide additional benefits beyond regular Medicare benefits. This includes dental and vision coverage, along with other benefits like gym memberships. Many plan participants find these extra benefits extremely useful.