What is Medicare Part C (Medicare Advantage)

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Once you enroll in both parts of Original Medicare, you can elect to enroll in Medicare Part C. It’s important to educate yourself on the different types of Medicare Part C plans, what they cover, who’s eligible and the costs associated with these policies.

What is Medicare Part C?

Medicare Part C, or “Medicare Advantage,” is Medicare coverage offered by a private insurance company. You can sign up for Medicare Advantage instead of Original Medicare Parts A and B and a Medigap policy. All Advantage plans offer Part A and B benefits, but many have additional coverage. Advantage plans can be PPOs, HMOs, PFFS, SNP, HMP-POS or MSA and they operate much like the health insurance coverage you may have had in the past from an employer.

What Does Medicare Part C Cover?

Medicare Part C definition states that these policies must cover all medically necessary services that are covered under Part A Medicare (hospitals) and Part B (medical expenses). This means that any policy will cover:

  • Hospitalization in a semi-private room
  • Doctor visits
  • Outpatient services
  • Tests, including blood tests, X-rays, CT Scans and MRIs
  • Emergency room visits
  • The cost of durable home health equipment like oxygen and walkers

Many Part C Medicare plans also cover preventive care and prescription drugs, some offer dental and vision benefits. If your plan does not offer all the benefits you want, you may be able to add prescription drug coverage by enrolling in a standalone Medicare Part D prescription drug plan. You can also get vision and dental coverage through independent insurance. However, if you enroll in Medicare Advantage, you cannot get Medicare Medigap plans to cover the things that Medicare Advantage does not.

Differences Between Part C Medicare and Original Medicare

Under Original Medicare Parts A and B, there are no provider networks – you can go to any doctor or hospital you want, so long as they accept Medicare. Medicare Part C policies offer coverage through HMOs and PPOs. For each, there’s a list of “in-network” healthcare providers. If you go to a provider who is not in the network, your claim may not be covered (especially if you join an HMO), or you will usually pay more for the out of network doctor’s services. You can find more frequently asked questions regarding Medicare Advantage vs Medicare Supplement here.

Medicare Part C Costs

There are two components to your Part C premium: Medicare Parts A and B coverage, and additional coverage offered by your Part C plan. Part A coverage is free for most people, and the standard Medicare Part B Premium for 2018 is $134 (though your premium may be more or less than this).

You’ll pay this same Part B premium if you have a Part C plan, but you may also pay an additional premium to cover the other benefits your plan offers. Premiums may vary widely, depending on the plan you choose and the state you live in.

Part C plans are much less standardized than Original Medicare or Medigap, and that means your out of pocket costs will also depend on the plan you choose and the state you live in. Different plans have different co-pays, deductibles, out of pocket maximums and rules about in-network vs out of network providers. That’s why it’s important to be informed and shop around when looking for Part C coverage.

When Can I Sign Up for Medicare Part C

You can sign up for a Part C Medicare during an Open Enrollment Period. The first of these begins three months before the month you turn 65 and ends three months after the month you turn 65. There is also an Open Enrollment Period every year from October 15 to December 7th. During this time, you are free to change your Advantage plan, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage to Original Medicare. There is also a second Open Enrollment Period specifically for switching from Medicare Advantage to Original Medicare and adding prescription drug coverage. That period runs from January 1 to February 14th each year. Click here for more information on when to sign up for Medicare.

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