Medicare Part C is an alternative way to get your Medicare coverage

Medicare Part C, also called Medicare Advantage, is a plan sold by private insurance companies that bundles your hospital coverage (Part A), doctor coverage (Part B), and usually prescription drug coverage (Part D) into one plan. You still pay your Part B premium to Medicare, but you get all your benefits through the private insurer instead of Original Medicare.

The key difference: with Original Medicare, you can see any doctor or hospital that accepts Medicare. With Part C, you typically must use doctors and hospitals in the plan's network, unless it's an emergency. Most Part C plans also have a maximum out-of-pocket limit — a yearly cap on what you pay — which Original Medicare does not have.

Part C is optional. You can stay on Original Medicare (Parts A and B) instead, or switch between them during certain times of the year. Many people choose Part C because the monthly premium is often lower than Original Medicare plus a separate Medigap policy, and because the out-of-pocket cap provides predictability.

Key Takeaways

  • Medicare Part C combines hospital, doctor, and usually drug coverage into one private plan, whereas Original Medicare splits these across different programs.
  • Part C plans require you to use in-network doctors and hospitals in most cases, and they set a yearly limit on how much you pay out of pocket.
  • You still pay your Part B premium to Medicare each month, plus any premium the Part C plan charges, plus copays and coinsurance when you use care.
  • Part C is not required; you can keep Original Medicare instead, but you can only switch plans during the annual enrollment period or if you have a may have access to life event.
  • Different Part C plans offer different networks, drug formularies, and extra benefits like dental or vision, so comparing plans each year matters even if you already have one.

How Part C premiums and costs work

Most Medicare Part C plans charge a monthly premium on top of your Part B premium. Some plans have a $0 premium, meaning you pay only your Part B premium to Medicare and nothing extra to the insurer — but these plans often have higher copays or coinsurance when you use care. Other plans charge $50 to $200 or more per month but may have lower copays.

When you use care, you also pay copays (a fixed amount per visit) or coinsurance (a percentage of the cost). These costs count toward your out-of-pocket maximum. Once you hit that limit in a calendar year, the plan pays 100% of covered services for the rest of the year. Original Medicare has no such cap, which means your costs can keep rising if you need a lot of care.

Part C plans almost always include prescription drug coverage (Part D), so you do not need to buy a separate drug plan. The plan's formulary — its list of covered drugs — determines which medications are covered and at what cost tier. If your current medications are not on the formulary, you may need to switch drugs or pay more.

Network restrictions and how they affect your choices

Most Part C plans are Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). HMO plans require you to choose a primary care doctor and get referrals to see specialists; you can only see doctors in the network except in emergencies. PPO plans let you see any doctor in the network without a referral, and sometimes cover out-of-network care at a higher cost.

Some plans also offer Private Fee-for-Service (PFFS) or Special Needs Plans (SNPs), which have different rules. PFFS plans let you see any doctor who accepts the plan's terms, even if they are not in a published network. SNPs are designed for people with specific conditions (like diabetes) or situations (like living in a nursing home).

Before you join a Part C plan, check whether your current doctors are in the network. If your doctor is not listed, contact the plan directly to confirm — networks change, and the plan's website may not be fully current. If your doctor is out of network and you want to keep seeing them, Original Medicare or a Medigap policy may be a better fit.

Extra benefits Part C plans often include

Many Part C plans offer benefits that Original Medicare does not cover, such as dental care, vision exams and glasses, hearing aids, or gym memberships. These extras can add real value if you use them. However, the scope and quality of these benefits vary widely between plans and between regions.

Some plans cover routine dental cleanings and exams; others cover major work like crowns or root canals. Some include an annual eye exam and a glasses allowance; others do not. Before you enroll, read the plan's summary of benefits to see exactly what is covered and what you pay. Do not assume that because one plan offers dental, all plans in your area do.

These extra benefits can change from year to year. A plan that covered dental this year may reduce or drop that benefit next year. That is one reason to review your plan's details every fall during the annual enrollment period, even if you have been happy with it.

When you can enroll in or switch Part C plans

You can join a Part C plan when you first become may be able to access for Medicare (usually at 65) or during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. Changes take effect January 1 of the following year.

If you miss the AEP, you generally cannot join a Part C plan until the next AEP, unless you have a may have access to life event such as moving out of your plan's service area, losing employer coverage, or becoming may be able to access for Medicaid. Some life events give you a 60-day window to make changes.

If you are already on a Part C plan and want to switch to a different Part C plan or to Original Medicare, you can do so during AEP. If you switch to Original Medicare, you have a 12-month window to buy a Medigap policy without medical underwriting — meaning the insurer cannot deny you or charge more based on your health.

Part C versus Original Medicare plus Medigap

The main trade-off is flexibility versus cost predictability. Original Medicare lets you see any doctor or hospital in the country that accepts Medicare, with no network restrictions. But you pay a Part B premium, and you may want to buy a separate Medigap policy to cover the gaps (copays, coinsurance, deductibles). Medigap premiums vary by plan and insurer, but a good Medigap policy can cost $100 to $300 per month.

Part C typically costs less in total monthly premiums because the out-of-pocket cap limits your exposure. But you are locked into a network and may face higher copays for specialists or urgent care. If you travel frequently or see doctors in multiple states, Original Medicare is usually more convenient.

There is no universally "better" choice — it depends on your health, your doctors, your budget, and how much you value network flexibility. Many people switch between Part C and Original Medicare over time as their circumstances change.

How to compare Part C plans in your area

Medicare.gov has a plan comparison tool where you can enter your zip code and see all Part C plans available to you. You can filter by premium, network type, and extra benefits. The tool also shows you whether your doctors are in each plan's network, if you enter their names.

When comparing, look at the total cost you expect to pay: the monthly premium, plus the copays for the services you use most often, plus any out-of-pocket costs before you hit the out-of-pocket maximum. If you take prescription drugs, check whether they are on each plan's formulary and at what tier (tier 1 drugs cost less than tier 4 drugs).

Read the plan's Summary of Benefits and Coverage document, not just the marketing materials. The summary tells you exactly what is covered, what you pay, and what is not covered. If you have questions, call the plan's customer service number — it is listed in the summary — and ask about specific services or drugs.

Frequently Asked Questions

Can I have both Medicare Part C and Medigap at the same time?

No. If you are enrolled in Part C, you cannot buy a Medigap policy. Medigap is designed to work with Original Medicare. If you want Medigap, you must disenroll from Part C and switch to Original Medicare during the Annual Enrollment Period.

What happens to my Part C coverage if I move to a different state?

Most Part C plans are regional and do not cover care outside their service area except in emergencies. If you move out of your plan's service area, you can disenroll and join a different Part C plan in your new location, or switch to Original Medicare. You have a 60-day window to make this change without penalty.

Do Part C plans cover care outside the United States?

Most Part C plans do not cover routine care outside the U.S., though some cover emergency care while you are traveling. If you spend significant time abroad, check with the plan before enrolling. Original Medicare also has limited international coverage, so this is a consideration either way.

Can my Part C plan drop me or raise my premium without warning?

Plans can change their premiums, copays, and benefits from year to year, and they must notify you by September 30 each year of changes taking effect January 1. Plans can also discontinue service in your area, though they must give you notice and a chance to switch. You are never locked in permanently.

What if my Part C plan does not cover a service I need?

You can appeal the denial through the plan's grievance process. If the appeal is denied, you can file a complaint with Medicare. During the Annual Enrollment Period, you can also switch to a different Part C plan or to Original Medicare that may cover the service you need.