Medicare Part C is an alternative way to get your Medicare benefits through a private insurance company

Medicare Part C, also called Medicare Advantage, is a plan sold by private insurance companies that combines Part A (hospital), Part B (medical), and usually Part D (prescription drugs) into one plan. Instead of getting your benefits directly from the government, you enroll in a private plan that contracts with Medicare to provide your coverage. You still pay your Part B premium to Medicare, but the insurance company becomes responsible for delivering your benefits.

Part C plans must cover everything that Original Medicare covers — hospital stays, doctor visits, lab work, imaging, and emergency care. Most Part C plans also include prescription drug coverage and extras that Original Medicare does not, such as dental, vision, or hearing benefits. However, the way you access care and what you pay out of pocket can be very different from Original Medicare.

Key Takeaways

  • Medicare Part C covers all the same hospital and medical services as Original Medicare, plus prescription drugs in most plans.
  • Part C plans often include dental, vision, hearing, and fitness benefits that Original Medicare does not cover.
  • You must use doctors and hospitals in the plan's network, except in emergencies, or pay higher out-of-pocket costs.
  • Part C plans have an annual out-of-pocket maximum that limits your total costs, unlike Original Medicare.
  • You can switch to a different Part C plan or return to Original Medicare during the annual enrollment period each fall.

Hospital and doctor coverage under Part C

Part C covers inpatient hospital care, including room, meals, nursing care, and hospital-ordered medications. You are covered for up to 90 days per benefit period, the same as Original Medicare. If you need a longer stay, Part C plans cover an additional 60 lifetime reserve days, after which you pay the full cost.

For doctor visits, Part C covers office visits, specialist consultations, preventive care (like annual wellness exams and cancer screenings), and lab work. You typically pay a copay at each visit — often $10 to $50 depending on the plan — rather than the coinsurance you would pay under Original Medicare. The exact copay varies by plan and by type of visit.

Part C plans require you to use doctors and hospitals in their network. If you see an out-of-network provider without a referral, you will pay much more out of pocket, or the plan may not cover the visit at all. Emergency care is covered even outside the network, but you should call the plan to confirm coverage as soon as you are able.

Prescription drug coverage included in most Part C plans

Most Part C plans include Part D prescription drug coverage, so you do not need to buy a separate drug plan. The plan covers brand-name and generic medications on a formulary — a list of drugs the plan covers. You typically pay a copay per prescription, which ranges from $5 to $50 or more depending on the drug and the plan.

Part C drug coverage works the same way as standalone Part D: you move through different cost phases as you spend money on drugs. Once you reach the annual out-of-pocket maximum for the plan, the plan covers most remaining drug costs for the rest of the year. If a drug you take is not on the formulary, you can ask the plan for an exception, though approval is not may provide.

Extra benefits Part C plans often cover

Many Part C plans include benefits that Original Medicare does not pay for. Common extras are dental (cleanings, fillings, extractions), vision (eye exams, glasses, contact lenses), and hearing (exams and hearing aids). Some plans also cover fitness programs, transportation to medical appointments, or over-the-counter health items like pain relievers or blood pressure monitors.

These extras vary widely by plan and by region. A plan available in one county may offer dental coverage, while the same insurance company's plan in a neighboring county may not. You need to check the specific plan's benefits document to see what is included. The plan must list all covered services and costs in its Summary of Benefits and Coverage, which you can request or view online.

Out-of-pocket costs and annual limits

Part C plans have an annual out-of-pocket maximum — a dollar amount set by Medicare each year. Once you reach this limit by paying copays, coinsurance, and deductibles, the plan covers most remaining care for the rest of the year. This is different from Original Medicare, which has no annual limit on what you pay out of pocket.

The out-of-pocket maximum varies by plan but is capped by Medicare at a certain amount each year. Plans may also have deductibles — an amount you pay before the plan starts to help — though many Part C plans have no deductible. You should compare the deductible, copays, and out-of-pocket maximum across plans to understand your total costs.

Services Part C does not cover

Part C covers the same services as Original Medicare, so it does not cover long-term care (nursing home stays beyond the first 100 days), custodial care, or most dental and vision care — unless the specific plan includes those as extras. Part C also does not cover routine foot care, hearing aids (unless the plan includes them), or most cosmetic procedures.

If you need care outside the United States, Part C plans typically do not cover it, though some plans offer limited emergency coverage abroad. If you travel frequently or live part of the year outside the country, ask the plan about its coverage rules before you enroll.

How to enroll in Part C and when you can switch

You can enroll in Part C during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Coverage begins January 1 of the following year. If you are new to Medicare, you have a 3-month window around your 65th birthday to enroll without penalty.

Once you are enrolled in Part C, you can switch to a different Part C plan or return to Original Medicare during the Annual Enrollment Period. If you return to Original Medicare, you may want to enroll in a standalone Part D drug plan and a Medigap plan (supplemental insurance) at the same time, because waiting to enroll later can result in higher premiums.

Frequently Asked Questions

Can I use my current doctor with Part C?

Only if your doctor is in the plan's network. Before you enroll, check the plan's provider directory to confirm your doctor participates. If your doctor is not in the network, you can ask the plan for an exception, though approval is not may provide. Some plans allow you to see out-of-network doctors at a higher cost.

What happens if I need emergency care while traveling?

Part C plans cover emergency care anywhere in the United States, even outside the network. You should call the plan as soon as you are able to report the emergency. Non-emergency care while traveling is usually not covered unless the provider is in the network, so plan ahead if you travel frequently.

Do I still pay my Part B premium with Part C?

Yes. You pay your Part B premium to Medicare, and the Part C plan premium (if any) to the insurance company. Some Part C plans have no monthly premium beyond Part B, while others charge an additional premium. The plan's premium is listed in its marketing materials and enrollment documents.

Can I go back to Original Medicare if I do not like my Part C plan?

Yes, during the Annual Enrollment Period from October 15 to December 7. You can switch to a different Part C plan or return to Original Medicare. If you return to Original Medicare, you should also enroll in a Medigap plan and a Part D drug plan during the same period to avoid coverage gaps.

What if my Part C plan is discontinued?

If your plan ends, Medicare will send you a notice and you will have a special enrollment period to choose a new Part C plan or return to Original Medicare. You do not lose coverage during this transition, but you should act quickly to avoid gaps in your preferred provider access.