What is Medicare Part C (Medicare Advantage)?

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Medicare Part C coverage is also referred to as Medicare Advantage coverage and is provided and administered by private health insurance companies that contract with Medicare. Medicare Part C insurance covers everything covered by Medicare Parts A and B (Original Medicare) and can also provide coverage for other medical needs.

Medicare Part C (Medicare Advantage) Eligibility

Persons must be enrolled in Original Medicare and have Medicare Part A and B coverage in place in order to be eligible for Medicare Part C (Medicare Advantage) coverage.

Medicare Advantage coverage is administered by private insurance companies and persons with Medicare Advantage coverage are not eligible for Medicare Supplement Insurance (Medigap) at the same time. Medigap covers some expenses not covered by Original Medicare such as coinsurance and deductibles.  Medigap coverage is only available to persons covered by Original

Medicare under Parts A and B. Some people prefer Original Medicare coverage with additional Medigap coverage to Medicare Advantage coverage.

Persons with end-stage renal disease (ESRD) are generally not eligible for Medicare Part C coverage. There are some forms of special needs plans available for persons with ESRD who are currently covered by Medicare Parts A and B.

Learn more about applying for Medicare

Medicare Part C Enrollment

Persons Covered by Medicare Parts A and B Can Enroll Directly With Private Insurance Companies

Enrolling in Medicare Part C usually simply requires signing up directly with a qualified insurance company. It is important that you understand premium costs, covered care and expenses, and out of pocket expenses before signing up for Medicare Part C coverage.

Private insurance companies that are qualified to provide and administer Medicare Part C coverage are paid directly by the federal government to cover individual enrollees.

Medicare Part C Insurance Is Usually Limited to In-Network Providers

Medicare Part C plans are usually part of health maintenance organizations (HMOs) or preferred provider organizations (PPOs).

HMO coverage requires that you choose a primary care doctor who will provide referrals for care from specialists and other covered services. PPO coverage usually allows covered individuals to choose providers and services from a plan network without referrals.

Plans are normally limited in geographic range. When using providers or services out of a plan’s network, out of pocket costs are usually more expensive.

Medicare Part C Coverage

Medicare Part C coverage is required by law to provide all the coverages provided by Medicare Parts A and B. There are several additional benefits that may be available under Medicare Part C coverage.

Hospital Coverage

Similar to Medicare Part A coverage, Medicare Part C covers inpatient hospital care, nursing home care, and skilled nursing facility care. Inpatient care normally requires that the care includes necessary medical treatment in addition to residential services. Medicare Part C does not provide hospice care coverage, but that coverage is still provided to covered persons through Medicare Part A.

Home Health Care Coverage

Some home health care is covered, including part-time skilled nursing care, physical therapy, and rehabilitation.

Outpatient Health Care

Medicare Part C coverage provides benefits for the same outpatient medical services covered by Medicare Part B.

Covered services include doctor visits, preventative care, X-rays and lab work, emergency ambulance services, mental health care, and necessary medical equipment (for example, wheelchairs, walkers, and oxygen tanks and equipment).

Additional Medicare Part C Benefits In Addition to Parts A and B Coverage

Coverages in Medicare Part C plans vary in costs and in the additional services provided. For example, some dental or vision coverage may only apply when necessary because of illness or injury. Routine care may be covered, but you should expect additional premium costs for additional services. It is always very important to be sure that you understand the coverages you are signing up for and the expenses involved.

Additional coverages under Medicare Part C plans can include:

  • Dental care including cleanings, x-rays, and other treatments
  • Vision care including routine tests, glasses, and contacts
  • Hearing care including tests and hearing aids
  • Preventative and wellness care including therapy and exercise training

Prescription Drug Coverage

Another additional coverage that Medicare Part C plans provide in addition to typical Original Medicare coverage is for prescription medications. A covered prescription drug plan will be controlled by Medicare Part D and usually provides a list of covered medications that can change from time to time. It is very important that you check covered medications against prescriptions that you currently have or expect to have.

Medicare Part C Premiums

After enrolling in a Medicare Plan C plan, you will still pay the monthly Medicare Plan B premium previously in place. Each Medicare Part C plan can have different costs depending on the coverages provided and the location of the plan, as well as other factors. Some Medicare Part C plans do not charge additional monthly premiums in addition to the existing Medicare Part B monthly premium, while other plans have additional monthly premiums that are charged.

All Medicare Part C plans are required to have a specified yearly out-of-pocket maximum. This caps the amount a patient must pay and all additional covered expenses are paid by the Part C plan. This cap is not available under Medicare Parts A and B coverage.

Medicare Part C Deductibles

Deductibles are annual amounts that must be paid out-of-pocket before a Medicare Part C plan begins to pay covered expenses. Some plans do not have deductibles and others have deductibles that apply separately to prescription medicines. This is another area where it is critical to understand the expenses and costs involved before signing up with a plan.

Medicare Part C Coinsurance and Copayments

Medicare Part C plans offer different options regarding copayments and coinsurance. Some copayments apply only to prescriptions, while others apply to office visits and appointments with specialists.

Other Medicare Coverages

Medicare Part C involves Medicare Advantage plans that combine parts of coverages under Medicare Parts A and B. Medicare Part D involves prescription drug coverage. Click the links below for more information on the other parts of Medicare coverage.