Part C costs vary by plan and location, but most people pay a monthly premium to the insurance company, not to Medicare

Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Instead of paying Medicare directly, you pay a private insurance company a monthly premium. That premium amount depends on which plan you choose, where you live, and what the insurance company decides to charge that year.

Most Part C plans have a premium of $0 to $200 per month, though some plans cost more. Many plans in rural areas or with lower enrollment have higher premiums. Some plans in competitive urban markets have $0 premiums — meaning you pay nothing extra beyond your Part B premium, which you still owe to Medicare.

The insurance company sets the premium each year and can change it. You will see the new premium when you get your plan materials in the fall, before the January 1 start date. If the premium goes up and you do not want to pay it, you can switch to a different plan or go back to Original Medicare during the annual enrollment period (October 15 to December 7).

Key Takeaways

  • Part C premiums are paid to the insurance company each month, and most plans charge between $0 and $200, though costs vary by location and plan type.
  • You still pay your Part B premium to Medicare even if you choose Part C, and you may also pay copays or coinsurance when you use care.
  • Part C plans have an out-of-pocket maximum, which is a yearly limit on what you pay for covered services — once you hit it, the plan pays 100 percent.
  • Premiums and coverage change every year, so you should review your plan each fall during open enrollment to see if a different plan would cost less.
  • If your plan's premium increases and you want to avoid the higher cost, you can switch to Original Medicare or a different Part C plan during the annual enrollment period.

What you pay beyond the monthly premium

The monthly premium is only one cost. When you see a doctor or use a hospital, you also pay copays (a fixed amount per visit) or coinsurance (a percentage of the bill). These amounts differ by plan and by type of service.

For example, one plan might charge $25 to see your primary care doctor and $250 for an emergency room visit. Another plan might charge $40 for the doctor and $500 for the emergency room. You need to look at your plan's summary to know what you will owe.

Part C plans also have an out-of-pocket maximum. This is a yearly limit — once you have paid that amount in copays and coinsurance combined, the plan pays 100 percent of your covered services for the rest of the year. The out-of-pocket maximum for 2024 is capped by Medicare at $8,050 for in-network care, but individual plans may set a lower limit. Plans in 2025 will have a different cap; check your plan documents for the exact number.

How Part C premiums compare to Original Medicare costs

Original Medicare (Parts A and B) has no monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. Part B has a monthly premium that most people pay — it was $164.90 per month in 2024, but increases each year. You also pay a deductible ($240 in 2024 for Part B) and copays or coinsurance for each service.

Part C bundles everything into one plan with one premium, one deductible, and one out-of-pocket maximum. If you choose a $0-premium Part C plan, you avoid the Part B premium — but you still owe it to Medicare, and the insurance company factors that into their plan design. You are not actually saving money; the plan is structured differently.

Whether Part C or Original Medicare costs less depends on how much care you use. If you see many doctors or take many medications, the out-of-pocket maximum in Part C may protect you from very high bills. If you rarely see a doctor, Original Medicare with a Medigap supplemental policy might cost less overall. Compare your options each year during open enrollment.

Prescription drug coverage and Part C

Most Part C plans include prescription drug coverage (called Part D). This means your medications are covered under the same plan as your medical care, and you pay copays for drugs at the pharmacy. The copay amount varies by plan and by drug.

Some Part C plans do not include drug coverage. If you choose one of these plans, you must enroll in a standalone Part D plan through Medicare, or you may owe a penalty if you go without coverage for more than 63 days in a row.

Like all Part D plans, Part C plans with drug coverage have a coverage gap (sometimes called the "donut hole") where you pay more out of pocket for medications in the middle of the year. The details of this gap change yearly. Your plan materials will show exactly when the gap applies and what you will pay during it.

Extra benefits and why they affect cost

Many Part C plans offer benefits that Original Medicare does not cover, such as dental, vision, hearing aids, or fitness programs. These extra benefits can make a plan attractive even if the premium is higher than another plan's. However, these benefits often come with limits — for example, a dental benefit might cover only two cleanings per year or cap the annual benefit at $1,000.

Plans with more generous extra benefits usually charge higher premiums or have higher copays. A plan with $0 premium but no dental coverage may cost less overall than a plan with a $100 premium and full dental coverage, depending on whether you need dental work. Review what each plan covers and what you actually use before choosing based on extra benefits alone.

When and how to review your Part C costs

Medicare sends plan materials to your home each fall. These materials show the premium, deductible, copays, coinsurance, out-of-pocket maximum, and covered services for the coming year. Read them carefully, because costs change every January 1.

You can also compare plans on Medicare.gov. Enter your zip code and current medications (if you want to see drug costs), and the website will show you all available plans, their premiums, and their out-of-pocket costs for your situation. This tool is free and does not require you to log in.

If your current plan's costs are going up and you want to switch, you have until December 7 each year to make a change. The new plan starts January 1. If you miss this important date, you are locked into your current plan until the next open enrollment period in October.

Frequently Asked Questions

Do I have to pay Part B premium if I am in Part C?

Yes. Part B premium is separate from Part C premium. You pay Part B to Medicare and Part C premium to the insurance company. Some Part C plans have a $0 premium, but you still owe Part B. If you do not pay Part B, you lose Part C coverage as well.

What happens if I cannot afford my Part C premium?

Contact your plan's customer service to ask about hardship programs or payment plans. Some plans offer information for people with low income. You can also switch to Original Medicare or a different Part C plan during open enrollment if your current plan becomes unaffordable.

Can my Part C premium go up in the middle of the year?

No. Premiums are locked in for the calendar year. They can only change on January 1. If your plan raises the premium for next year and you do not want to pay it, you can switch plans or return to Original Medicare during the October 15 to December 7 open enrollment period.

Does my out-of-pocket maximum include the monthly premium?

No. The out-of-pocket maximum counts only copays and coinsurance for covered services. Monthly premiums are separate. Once you reach the out-of-pocket maximum, the plan pays 100 percent of covered services, but you still owe your monthly premium.

What if I use doctors outside my Part C network?

Most Part C plans are HMOs or PPOs with network restrictions. HMO plans usually do not cover out-of-network care except emergencies. PPO plans cover out-of-network care but at a higher copay or coinsurance. Check your plan documents to see which type you have and what out-of-network costs are.