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 insurance (Part A), doctor visits (Part B), and usually prescription drug coverage (Part D) into one plan. Instead of getting coverage directly from Medicare, you enroll in a private plan that agrees to provide all the same benefits Medicare would cover — but often with different costs, rules about which doctors you can see, and extra benefits like dental or vision.

The key difference from Original Medicare (Parts A and B) is that a private company manages your care and decides what it will pay for, rather than Medicare itself. You still pay a monthly premium to Medicare, but you also pay the private plan. Most Part C plans include prescription drug coverage automatically, so you do not need to enroll in Part D separately.

Key Takeaways

  • Medicare Part C is sold by private insurance companies and includes hospital, doctor, and usually drug coverage in one plan.
  • Most Part C plans require you to use doctors and hospitals in their network, and many require referrals to see specialists.
  • Part C plans often have lower monthly premiums than Original Medicare plus a separate drug plan, but may have higher costs when you need care.
  • You can switch to Original Medicare or change Part C plans during the annual enrollment period from October 15 to December 7.
  • Part C plans vary widely by location and year, so comparing plans in your area is necessary to find the best fit for your health needs.

How Part C plans work differently from Original Medicare

With Original Medicare, you go to any doctor or hospital that accepts Medicare, and Medicare pays its share directly. With Part C, you choose a specific plan run by a private company, and that company controls which providers you can see and what services it will cover. Most Part C plans are HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations). HMOs typically require you to pick a primary care doctor and get referrals to see specialists; PPOs give you more freedom to see specialists without a referral but charge more when you go out of network.

Part C plans also set their own rules about prior authorization — meaning the plan may require your doctor to get permission before ordering certain tests, procedures, or medications. If the plan denies a service, you have the right to appeal, but the process takes time. With Original Medicare, there is no network restriction; you straightforward show your Medicare card to any willing provider.

Because Part C plans take on the financial risk of covering your care, they often include benefits that Original Medicare does not — such as dental cleanings, vision exams, hearing aids, or fitness programs. These extras vary by plan and location. Some plans also offer lower out-of-pocket costs if you use their network providers.

What you pay with a Part C plan

You pay three types of costs with Medicare Part C. First, you still pay your Part B premium to Medicare each month (currently $164.90 for most people in 2024, though this changes yearly). Second, you pay a monthly premium to the private plan itself — which can be as low as $0 but often ranges higher depending on the plan and your location. Third, you pay out-of-pocket costs when you use care: copayments for doctor visits, coinsurance for hospital stays, and deductibles before coverage kicks in.

The out-of-pocket costs in Part C plans vary widely. Some plans have low monthly premiums but high copayments; others charge more per month but less when you need care. Part C plans have an annual out-of-pocket maximum — a cap on what you pay in a year — which protects you from catastrophic costs. Once you hit that limit, the plan pays 100 percent of covered services for the rest of the year. Original Medicare has no such cap, which is why some people choose Part C for this protection.

If you need prescription drugs, most Part C plans include drug coverage, so you do not pay a separate Part D premium. However, the plan controls which drugs it covers and at what cost, and you may need prior authorization for expensive medications.

Choosing a Part C plan in your area

Part C plans are not available everywhere, and the plans offered in your county change each year. To see what plans are available where you live, you can visit Medicare.gov and use their plan finder tool, or call 1-800-MEDICARE. You will need your zip code to search. Plans vary by premium, network doctors and hospitals, drug formulary (the list of covered medications), and extra benefits.

When comparing plans, check whether your current doctors and hospitals are in the network. Call your doctors' offices to confirm they accept the plan you are considering — just because a plan lists a hospital does not mean your specialist works there. Also review the drug formulary if you take prescription medications; some plans may not cover your drugs, or may cover them at a higher tier with a bigger copayment.

You can enroll in Part C during your initial enrollment period when you first turn 65, or during the annual open enrollment period from October 15 to December 7 each year. If you miss these windows, you may not be able to enroll until the next open enrollment period, unless you have a may have access to life event such as moving to a new state or losing other health coverage.

When Part C might be a good fit

Part C can work well if you want predictable costs with an annual out-of-pocket maximum, prefer having one plan to manage instead of separate Part A, B, and D plans, or value the extra benefits like dental or vision that many plans offer. It is also a reasonable choice if you are generally healthy and do not see many specialists, because the lower premiums can save money over time.

Part C is less suitable if you have complex medical needs, see many specialists, or travel frequently outside your plan's service area. Because you must use in-network providers (with HMOs especially), switching plans or moving to a new state can disrupt your care. If you have a strong relationship with a doctor who does not accept your plan, you would need to change doctors or switch back to Original Medicare.

How to switch from Part C back to Original Medicare

You can leave a Part C plan and return to Original Medicare during the annual open enrollment period (October 15 to December 7) or during the Medicare Advantage disenrollment period (January 1 to February 14). When you switch, your coverage ends on the last day of the month in which you make the change, and Original Medicare begins on the first day of the next month.

If you switch back to Original Medicare, you will need to enroll in a separate Part D drug plan if you want prescription coverage, because Original Medicare does not include drugs. You can enroll in Part D at the same time you leave Part C, during the same open enrollment window. If you wait and enroll later, you may face a late enrollment penalty on your Part D premium.

Frequently Asked Questions

Can I use my Part C plan if I travel out of state?

Most Part C plans only cover care within their service area, which is usually one or a few counties. If you travel or move out of state, you may not have coverage except for emergency care. Some plans offer limited out-of-network coverage, so check your plan documents. If you travel frequently or split time between states, Original Medicare may be a better choice.

What happens if my Part C plan is discontinued?

Insurance companies sometimes stop offering a plan in your area. If this happens, Medicare sends you a notice and gives you the option to switch to another Part C plan or return to Original Medicare without penalty. You have until the end of the month following the notice to make your choice.

Do I need Medigap insurance with Part C?

No. Medigap policies are designed to work with Original Medicare and are not allowed to be sold alongside Part C. Part C plans include their own out-of-pocket limits and cost-sharing rules, so Medigap would be redundant and is not permitted.

Can I switch Part C plans without waiting until open enrollment?

Generally no, but there are exceptions. If you have a may have access to life event — such as moving, losing other coverage, or becoming may be able to access for Medicaid — you may be able to change plans outside the regular enrollment window. Contact Medicare to ask whether your situation qualifies.

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

If your doctor stops accepting your plan, the plan should notify you and may offer to cover a limited number of visits while you transition to a new doctor. You can also switch to a different Part C plan or return to Original Medicare during the next open enrollment period if losing your doctor is a hardship.