What Is Part C of Medicare Coverage?

What Is Part C of Medicare Coverage?

Part C of Medicare, commonly called Medicare Advantage, is an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. It combines the hospital and medical coverage of Original Medicare into a single plan, and most plans also include prescription drug coverage.

What Part C Covers

Medicare Advantage plans must cover everything Original Medicare covers, but they often add extras such as dental, vision, hearing, and wellness programs. Most plans include Part D prescription drug coverage, so you typically do not need a separate drug plan. Each plan sets its own rules for how you access care, such as using a network of doctors and hospitals.

How Part C Differs from Original Medicare

With Original Medicare, you can go to any doctor or hospital that accepts Medicare, and you do not need referrals. With Part C, you usually choose a primary care doctor and get referrals to see specialists. Out-of-pocket costs, provider networks, and prior authorization rules vary by plan, so comparing options is important.

Who Can Enroll in Part C

You are eligible for Medicare Advantage if you are 65 or older, or under 65 with certain disabilities, and you have both Medicare Part A and Part B. You must live in the plan's service area. You cannot have Part C and a Medigap policy at the same time, though you can leave a Medicare Advantage plan and return to Original Medicare during certain enrollment periods.

Costs and Plan Types

Medicare Advantage plans often charge a monthly premium, and many offer $0 premium options, but you still pay your Part B premium. Plan types include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service plans, and Special Needs Plans tailored for people with specific conditions. Each type has different rules about network use, referrals, and out-of-pocket limits.