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Medicare Part C: What You Need to Know

What is Medicare Part C?

Medicare Part C provides an alternative to Original Medicare (Medicare Part A and Medicare Part B). Offered by private health insurance companies that are approved by Medicare, Medicare Part C plans—also known as Medicare Advantage plans—are legally required to offer at least the same benefits that are provided from Original Medicare, but can include additional coverage, such as routine vision or dental benefits, prescription drugs or health wellness programs.

With a Medicare Part C Plan:

  • $0 premium plans and $0 deductible plans may be available in your area
  • Prescription drug coverage may be included
  • Additional benefits, such as vision, hearing and dental may be available
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Who is eligible to receive Medicare Part C coverage?

Any Medicare beneficiary, regardless of age, can purchase a Medicare Part C plan if they meet the following criteria:

  • Enrolled in both Medicare Part A and B – Some people mistakenly think they can drop Part B if they enroll in a Medicare Part C plan. However, if Part B is dropped, you will immediately lose your Part C plan so it is important to keep both Parts A and B when enrolling in Medicare Part C.
  • Choose a Plan in the County You Reside – Eligibility for Medicare Part C plans are based on the address you have on file with Social Security. You must choose a plan that operates in the county in which you live. Some plans will be specific to only one or two counties, while others might span the whole state.

The Cost of Medicare Part C

As mentioned above, Medicare Part C is an alternative to Original Medicare. Therefore, the same hospital and doctor’s benefits provided from Original Medicare are also provided by a Medicare Part C plan. However, instead of paying deductibles and 20% of your medical services, you will pay the Medicare Part C plan copays.

Each Medicare Part C plan has a summary of benefits which will list out various medical services and provide a summary that shows you what your copay or coinsurance will be for each service. For example, you might pay $15 for lab work, $75 for a specialist visit and $200 for an MRI. Some items might have a $0 copay, but everything you spend on Part A and B services counts toward your out-of-pocket maximum. If you hit that maximum, your Part C plan will pay 100% after that for the rest of the year.

Another advantage of Medicare Part C plans is that they often also include a built-in Medicare Part D drug plan. Additionally, some Medicare Part C plans provide coverage for dental, vision and hearing care.

Enrolling in Medicare Part C

You can enroll in a Medicare Part C plan during your Initial Enrollment Period, if you qualify for a Special Enrollment Period or during the Medicare Annual Enrollment Period, held each year October 15-December 7.

The Medicare Advantage Open Enrollment Period (OEP) runs January 1-March 31. If you are enrolled in a Medicare Part C Plan, you have a one-time opportunity to:

  • Switch to a different Medicare Part C Plan
  • Drop Medicare Part C and return to Original Medicare (Parts A and B)
  • Sign up for a stand-alone Medicare Part D Prescription Drug plan, if you elected to return to an Original Medicare plan

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