Medicare Part C costs vary by plan and region, but most people pay a monthly premium between $0 and $200, plus a yearly deductible that ranges from $0 to $500 or more

Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B) offered by private insurance companies approved by Medicare. The total cost depends on three things: the monthly premium you pay the insurance company, the deductible you meet before the plan starts paying, and the copays or coinsurance you pay when you use care. Some plans charge $0 monthly premium but have higher deductibles and copays. Others charge more upfront but cost less when you actually need care.

Your actual cost also depends on where you live. The same insurance company may charge different premiums in different counties. Income does not affect your Part C premium directly, but if your income is above a certain threshold, you may pay an extra amount called an Income-Related Monthly Adjustment Amount (IRMAA) on top of your Part B premium — this is separate from your Part C cost.

Key Takeaways

  • Part C monthly premiums range from $0 to over $200 depending on the plan and your location, and you must also pay your Part B premium to Medicare.
  • Deductibles, copays, and coinsurance vary widely between plans, so a low-premium plan may cost more overall if you use a lot of care.
  • You can change your Part C plan once a year during the Annual Enrollment Period (October 15 to December 7), or switch to Original Medicare during the same window.
  • Extra benefits like dental, vision, and hearing coverage are common in Part C plans but vary by plan and location.
  • If your income rises above certain limits, you will pay an extra amount (IRMAA) added to your Part B premium, not your Part C premium.

The three parts of what you pay: premium, deductible, and copays

The monthly premium is what you pay the insurance company every month to have the plan. This is separate from your Part B premium, which you still owe to Medicare. Some Part C plans have $0 premiums, meaning you only pay what Medicare charges for Part B. Other plans charge $50, $100, or more per month. The premium you see advertised is usually the lowest one available in your area — your actual premium depends on which specific plan you choose.

The deductible is the amount you pay out of your own pocket before the plan starts to help pay for care. Part C deductibles range from $0 to $500 or higher, depending on the plan. A plan with a $0 deductible means you start paying copays when ready. A plan with a $300 deductible means you pay the first $300 of covered care yourself, then the plan begins to share costs with you.

Copays and coinsurance are what you pay each time you use a service. A copay is a flat dollar amount — for example, $25 for a doctor visit or $10 for a prescription. Coinsurance is a percentage of the cost — for example, 20% of the cost of an imaging test. Part C plans have an out-of-pocket maximum, usually between $5,000 and $7,500 per year. Once you reach that limit, the plan pays 100% of covered services for the rest of the year.

How location and plan type affect your cost

The same insurance company charges different premiums in different parts of the country. A plan that costs $50 per month in one county may cost $120 in another county 50 miles away. This is because insurance companies set rates based on local healthcare costs and the number of people in the plan. Before you compare plans, you need to know which plans are actually sold in your county.

Plan type also changes the cost structure. Health Maintenance Organization (HMO) plans usually have lower premiums and copays but require you to use doctors and hospitals in their network. Preferred Provider Organization (PPO) plans cost more but let you see out-of-network doctors, though you pay more when you do. Private Fee-for-Service (PFFS) plans are rare and work differently — the plan, not Medicare, sets what it will pay providers.

Extra benefits bundled into the plan also affect cost. Many Part C plans include dental coverage, vision coverage, hearing aids, or fitness programs at no extra charge. Plans that offer these benefits may have higher premiums than plans that do not. If you use these services, a plan with bundled benefits may cost less overall than a low-premium plan where you pay out of pocket for dental and vision.

Income-Related Monthly Adjustment Amount (IRMAA) and how it works

If your income is above a certain level, Medicare charges you an extra amount called IRMAA. This is added to your Part B premium, not your Part C premium, but it affects your total monthly cost. For 2024, IRMAA kicks in if your modified adjusted gross income is above $97,000 for a single person or $194,000 for a married couple filing jointly. The thresholds change each year.

IRMAA has five income brackets, and the higher your income, the more you pay. The extra amount can range from about $70 per month to over $300 per month on top of your regular Part B premium. Medicare calculates IRMAA based on your tax return from two years ago, so if your income dropped recently, you can request a recalculation.

IRMAA does not directly change your Part C premium, but it increases your total out-of-pocket cost for Medicare. If you are subject to IRMAA, factor this into your budget when comparing Part C plans.

When and how to compare plans and lock in your choice

You can change your Part C plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect January 1. You can also switch from Part C to Original Medicare during this same window, or switch from Original Medicare to Part C if you have not already done so.

To compare plans in your area, use the Medicare Plan Finder tool on Medicare.gov. Enter your zip code and the medications you take, and the tool shows all available plans, their premiums, deductibles, copays, and which doctors and hospitals are in network. You can sort by monthly cost, out-of-pocket maximum, or specific benefits like dental or vision.

When you find a plan you want, you can enroll through Medicare.gov, by phone at 1-800-MEDICARE, or directly through the insurance company. Enrollment is free — do not pay anyone to help you enroll. Once you enroll, you receive a membership card in the mail, usually within two weeks.

What happens if you miss the enrollment period or need to switch plans

If you miss the Annual Enrollment Period, you are generally locked into your current plan for the rest of the year. However, certain life events allow you to change plans outside the enrollment window. These include losing employer coverage, moving to a new state or county, getting married or divorced, or having a significant drop in income.

If one of these events happens, you have 60 days to make a change. You will need to document the event — for example, a letter from your employer saying coverage ended, or a divorce decree. Contact Medicare at 1-800-MEDICARE to report the event and find out which plans you can switch to.

If you are unhappy with your plan after enrolling, you have a 14-day trial period to switch to a different Part C plan or back to Original Medicare without penalty. This trial period starts the day you enroll or the day your coverage begins, whichever is later. After 14 days, you are locked in until the next Annual Enrollment Period.

Prescription drug coverage and Part D costs

Most Part C plans include prescription drug coverage (Part D) built into the plan. This means you do not buy a separate Part D plan — the Part C plan covers both medical services and drugs. The cost of drug coverage is included in the plan's premium, deductible, and copays.

Some Part C plans do not include drug coverage. If you choose one of these plans, you must buy a separate Part D plan from another insurance company, or you will pay a penalty if you go without coverage. The penalty is 1% of the national average Part D premium for each month you were not covered, added to your Part D premium for the rest of your life.

Drug copays in Part C plans vary. Some plans charge a flat copay per prescription — for example, $10 for generic drugs and $35 for brand-name drugs. Others use a tiered system where copays depend on which tier the drug is on. A few plans charge coinsurance instead — a percentage of the drug cost.

Frequently Asked Questions

Can I switch from Part C back to Original Medicare if I change my mind?

Yes, during the Annual Enrollment Period (October 15 to December 7) you can switch to Original Medicare. If you switch, you have 63 days to buy a Medigap policy to cover what Original Medicare does not pay. After 63 days, insurance companies can deny you or charge more based on your health history.

Do I still pay my Part B premium if I have Part C?

Yes. Part C is an alternative way to receive your Part A and Part B benefits, but you still pay your Part B premium to Medicare. Your Part C premium is separate and goes to the private insurance company. If you have IRMAA, it is added to your Part B premium.

What is the out-of-pocket maximum and how does it work?

The out-of-pocket maximum is the most you will pay in copays and coinsurance in a year. Once you reach it, the plan pays 100% of covered services for the rest of that year. Out-of-pocket maximums in Part C plans typically range from $5,000 to $7,500, but vary by plan and location.

If a Part C plan shows $0 premium, what is the catch?

A $0 premium plan usually has higher deductibles, copays, or coinsurance than a plan that charges a monthly premium. The trade-off is lower upfront cost but higher costs when you use care. Compare the total out-of-pocket maximum and your expected usage, not just the premium.

How do I know if my doctor is in the Part C plan's network?

Use the insurance company's provider search tool on their website, or call the plan's customer service number. You can also ask your doctor's office directly whether they accept the plan. If your doctor is not in network and you want to keep seeing them, you may need to choose a different plan or switch to Original Medicare.