Medicare Part C is not free, but your costs depend on the plan you choose

Medicare Part C (also called Medicare Advantage) is an alternative way to get your Part A and Part B coverage through a private insurance company instead of Original Medicare. You still pay the Part B premium to Medicare — currently $164.90 per month for most people in 2024, though this amount changes yearly — but many Part C plans charge little or no additional premium on top of that. However, "no extra premium" does not mean free. You will pay out-of-pocket costs when you use care: copays for doctor visits, coinsurance for hospital stays, and deductibles before coverage begins.

The trade-off is real. Original Medicare has no network restrictions — you can see any doctor who accepts Medicare. Part C plans usually require you to use doctors and hospitals in their network, and you pay more if you go outside it. Some people pay less overall with Part C because the plans cap your yearly out-of-pocket spending. Others pay more because the copays and deductibles are higher than Original Medicare's costs.

Key Takeaways

  • You must pay the Part B premium to Medicare regardless of which plan you choose; Part C plans may add little or no extra premium, but you will have copays and deductibles when you use care.
  • Part C plans cap your yearly out-of-pocket costs, so your maximum spending is known in advance, whereas Original Medicare has no annual cap.
  • Network restrictions mean you typically must use in-network doctors and hospitals, and going outside the network costs significantly more.
  • Many Part C plans include dental, vision, and hearing coverage that Original Medicare does not cover, which can offset higher copays for some people.
  • Your costs vary by plan, by insurer, and by year, so comparing your options during open enrollment is the only way to know what you will actually pay.

What you pay to Medicare and what the plan charges on top

Every Medicare beneficiary pays a Part B premium to Medicare itself. For 2024, that is $164.90 per month for most people, though higher earners pay more through Income-Related Monthly Adjustment Amounts (IRMAA). This premium is the same whether you choose Original Medicare or Part C.

On top of that, your Part C plan may charge an additional monthly premium. Many plans charge zero dollars extra. Some charge $20 to $50 per month. A few charge more, depending on the insurer and the benefits included. Plans that include dental, vision, and hearing coverage often charge a higher premium than plans with basic benefits only. The premium you pay depends entirely on which plan you pick and where you live — the same plan may cost different amounts in different states or counties.

The Part B premium and any plan premium are separate from what you pay when you actually see a doctor or go to the hospital. Those are your out-of-pocket costs.

Out-of-pocket costs: copays, coinsurance, and deductibles

When you use care under Part C, you pay a copay (a fixed amount per visit) or coinsurance (a percentage of the cost). A typical copay might be $20 for a primary care visit or $50 for a specialist. A hospital stay might have a copay of $250 per day for the first few days, then nothing after that. These amounts vary by plan.

Most Part C plans also have a deductible — an amount you must pay out of your own pocket before the plan starts paying. Deductibles can range from $0 to several hundred dollars per year, depending on the plan. Once you meet your deductible, you start paying copays or coinsurance for covered services.

The important protection in Part C is the out-of-pocket maximum. Once your copays, coinsurance, and deductibles add up to this limit — typically $6,700 to $7,550 in 2024, though it varies by plan — the plan pays 100% of covered services for the rest of the year. Original Medicare has no such cap, so your costs can keep climbing indefinitely.

Network restrictions and what happens if you go out-of-network

Part C plans operate as 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 must use doctors and hospitals in the plan's network, or you pay the full cost yourself — the plan pays nothing. PPO plans are more flexible: you can see any doctor without a referral, but you pay less if you stay in-network.

This is a real cost difference. If you see an out-of-network doctor under an HMO, you typically pay 100% of the bill. Under a PPO, you pay more than the in-network copay, but the plan does cover part of it. Before you enroll in a Part C plan, check whether your current doctors are in the network. If your doctor is not listed, you will either need to switch doctors or pay out-of-pocket.

Emergency care is an exception. If you have a medical emergency, Part C plans cover emergency room visits and emergency transportation even if the facility is out-of-network. Once you are stabilized, you are expected to transfer to an in-network hospital if possible.

Extra benefits that may offset higher copays

Many Part C plans include benefits that Original Medicare does not: dental (cleanings, fillings, extractions), vision (eye exams, glasses, contacts), hearing (exams and hearing aids), and fitness programs (gym memberships or Silver Sneakers). Some plans cover over-the-counter items like pain relievers or blood pressure monitors. A few cover meal delivery or transportation to medical appointments.

These extras can add real value. If you need dental work or hearing aids, a Part C plan that covers those services might cost less overall than Original Medicare plus separate dental and hearing insurance. But the trade-off is the network restriction and higher copays for doctor visits. Run the numbers for your own situation: add up what you expect to spend on doctor visits, hospital care, and any dental or vision work you need, then compare that to the total cost under each plan option.

How to compare Part C plans and their costs

Every October, during Medicare Open Enrollment (October 15 to December 7), you can switch to a different Part C plan or switch back to Original Medicare. This is the only time most people can make changes. Before enrollment opens, Medicare mails you a booklet listing all Part C plans available in your area, along with their premiums, copays, deductibles, and covered benefits.

You can also use the Medicare Plan Finder tool on Medicare.gov. Enter your zip code, current doctors, and medications, and the tool shows you plans available to you, their costs, and whether your doctors are in-network. The tool does not make the decision for you, but it lets you see side-by-side what each plan costs and what it covers.

If you are new to Medicare (turning 65 or newly may be able to access), you have a one-time Initial Enrollment Period to join a Part C plan. If you miss that window, you can only join during Open Enrollment, unless you may have access to for a Special Enrollment Period due to a life event like moving or losing other coverage.

When Part C might cost you less than Original Medicare

Part C can be cheaper overall if you use a lot of care and hit the out-of-pocket maximum early in the year. Once you reach that limit, the plan covers everything for the rest of the year. With Original Medicare, you keep paying copays and coinsurance with no annual cap.

Part C is also cheaper if you need dental, vision, or hearing care and the plan covers it. Standalone dental and vision insurance for Medicare beneficiaries can cost $100 to $200 per month, so a Part C plan that includes these benefits at no extra premium or a small premium can save money.

Part C costs more if you rarely see a doctor and do not need dental or vision care. You are paying a premium (even if it is zero) and copays for every visit, whereas Original Medicare has no premium beyond Part B and no copays for preventive care. You also lose the freedom to see any doctor you want.

Frequently Asked Questions

Do I have to pay the Part B premium if I choose Part C?

Yes. The Part B premium goes to Medicare, not to your Part C plan. You pay Part B whether you choose Original Medicare or Part C. Your Part C plan premium, if any, is separate and goes to the insurance company.

What if I cannot afford the copays under my Part C plan?

If your income is low, you may may have access to for a Medicare Savings Program or Extra Help (Low-Income Subsidy) through your state or the federal government. These programs can pay your premiums and reduce your out-of-pocket costs. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to.

Can I switch Part C plans if I do not like the one I chose?

You can switch during Open Enrollment (October 15 to December 7 each year) or if you may have access to for a Special Enrollment Period. Outside these windows, you are locked into your plan for the year. Special Enrollment Periods explore if you move, lose other coverage, or experience certain life events.

Are prescription drugs covered under Part C?

Most Part C plans include prescription drug coverage (Part D). The copay for each drug depends on the plan and the drug's tier. Some plans charge $5 for generic drugs and $50 or more for brand-name drugs. You should review the drug formulary (the list of covered drugs) before enrolling to make sure your medications are covered.

What if my doctor leaves the Part C plan's network?

If your doctor leaves the network mid-year, the plan usually gives you a grace period to find a new in-network doctor or switch to a different plan. Contact your plan when ready if this happens. You may may have access to for a Special Enrollment Period to switch plans outside of Open Enrollment.