Medicare Part C combines your hospital, medical, and prescription drug coverage into one plan run by a private insurance company
Medicare Part C, also called Medicare Advantage, is an alternative way to get your Medicare benefits. Instead of using Original Medicare (Part A and Part B) plus a separate drug plan, Part C bundles hospital coverage, doctor visits, and prescription drugs into a single plan sold by a private insurer that contracts with Medicare.
The key difference: Original Medicare is run by the federal government. Part C plans are run by insurance companies like Humana, UnitedHealthcare, and Anthem. You still pay your Part B premium to Medicare, but the insurance company handles your actual coverage and claims.
Part C is not mandatory. You choose it instead of Original Medicare, not on top of it. If you enroll in Part C, you cannot use Original Medicare at the same time.
Key Takeaways
- Part C plans include hospital, doctor, and drug coverage in one policy, whereas Original Medicare requires you to buy a separate drug plan and possibly supplemental coverage.
- Part C plans often have lower or zero monthly premiums but typically require you to use doctors and hospitals in their network, and may require referrals for specialists.
- You can switch from Part C back to Original Medicare during the annual open enrollment period (October 15 to December 7) or if you move out of the plan's service area.
- Part C plans cover the same hospital and doctor services as Original Medicare, but may add extras like dental, vision, or fitness benefits that Original Medicare does not cover.
What Part C covers and what it does not
Part C covers everything Original Medicare Part A and Part B cover: hospital stays, doctor visits, emergency care, lab tests, imaging, and preventive services. It also includes prescription drug coverage (Part D) automatically, so you do not buy a separate drug plan.
Many Part C plans add benefits Original Medicare does not offer, such as dental cleanings, eyeglasses, hearing aids, or gym memberships. The specific extras vary by plan and by region. Some plans cover these at no extra cost; others charge a small copay.
Part C does not cover long-term care, custodial care, or nursing home stays beyond what Medicare Part A would cover. It also does not cover routine dental work, dentures, or cosmetic procedures — though some plans may cover limited dental services as an added benefit.
How Part C networks and referrals work
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. PPO plans give you more flexibility to see doctors outside the network, though you pay more when you do.
If you use an out-of-network doctor in an HMO plan, you typically pay the full cost yourself — the plan does not cover it, except in emergencies. PPO plans cover out-of-network care at a higher copay or coinsurance amount.
You must live in the plan's service area to enroll. If you move, you may need to switch plans or return to Original Medicare. Plans publish their network lists online, and you can check whether your current doctors are in-network before you enroll.
Part C costs: premiums, copays, and deductibles
Part C plans often have a lower monthly premium than Original Medicare plus a Medigap supplemental plan. Many plans charge zero premium beyond your Part B premium, though some charge $50 to $200 per month.
However, Part C plans typically have higher copays and deductibles than Original Medicare. You might pay $10 to $50 per doctor visit, $150 to $500 per hospital stay, and $5 to $50 per prescription, depending on the plan. Original Medicare has different cost-sharing: you pay 20% of approved charges after you meet your deductible.
Part C plans have an annual out-of-pocket maximum — usually $6,700 to $7,500 per year. Once you reach that limit, the plan covers 100% of your in-network care for the rest of the year. Original Medicare has no annual maximum.
When Part C makes sense and when it does not
Part C works well if you use doctors and hospitals regularly and want predictable copays. It also works well if you value the added benefits like dental or vision coverage, or if you prefer a single insurance card and one customer service line.
Part C may not work well if you travel frequently outside your plan's service area, if you see many specialists, or if you have a large network of doctors you want to keep. It also may not work well if you have complex medical needs and want the flexibility of Original Medicare, which lets you see any Medicare-approved doctor without referrals.
If you have both Medicare and Medicaid (dual may be able to access), some Part C plans are designed for you, but not all. Check with your state Medicaid office before enrolling.
How to enroll in Part C or switch back to Original Medicare
You can enroll in Part C when you first become may be able to access for Medicare (your Initial Enrollment Period) or during the annual open enrollment period from October 15 to December 7. Changes take effect January 1.
If you are already in Original Medicare, you can switch to Part C during open enrollment. If you are in a Part C plan and want to return to Original Medicare, you can do so during open enrollment as well. If you move out of your plan's service area, you can switch plans or return to Original Medicare outside the open enrollment window.
To enroll, you contact the insurance company directly, use Medicare.gov, or call 1-800-MEDICARE. You will need your Medicare card and Social Security number. The plan will confirm your enrollment and send you a new insurance card.
Part C versus Original Medicare plus Medigap: the main trade-offs
Original Medicare plus a Medigap supplemental plan gives you more flexibility: you can see any Medicare-approved doctor, no referrals required, and Medigap covers most of the costs Medicare does not. However, you pay three separate premiums (Part B, Medigap, and Part D drug plan) and manage three separate policies.
Part C bundles everything into one plan with one premium and one deductible, but limits you to in-network doctors and may require referrals. Part C plans often cost less per month but more per visit.
| Feature | Part C (Medicare Advantage) | Original Medicare + Medigap |
|---|---|---|
| Doctor choice | In-network only (HMO) or higher cost out-of-network (PPO) | Any Medicare-approved doctor |
| Referrals required | Usually yes for HMO; no for PPO | No |
| Monthly premium | Often $0–$200 | Part B + Medigap + Part D = $200–$400+ |
| Copays per visit | $10–$50 typical | Usually $0 after deductible (Medigap covers most) |
| Annual out-of-pocket max | Yes, usually $6,700–$7,500 | No limit |
| Extra benefits | Dental, vision, gym, hearing (varies by plan) | Not included |
| Prescription drug coverage | Included | Separate Part D plan required |
Frequently Asked Questions
Can I use my Part C plan when I travel out of state?
Most Part C plans cover emergency care anywhere in the United States. For routine care, you must use in-network doctors in your plan's service area. If you travel frequently or spend winters in another state, ask the plan whether they have doctors in that location, or consider Original Medicare instead.
What happens to my Part C coverage if I move?
If you move outside your plan's service area, you can switch to a different Part C plan in your new area or return to Original Medicare. You have 60 days from the date you move to make the change, and it takes effect the first of the month after you enroll.
Do I still pay my Part B premium if I have Part C?
Yes. You pay your Part B premium to Medicare every month, even if you are in a Part C plan. The Part C plan premium (if any) is separate. Some plans charge zero additional premium, but you always pay Part B.
Can I switch from Part C to Original Medicare outside of open enrollment?
Generally no, unless you move out of your plan's service area, lose coverage, or have a may have access to life event. The annual open enrollment period (October 15 to December 7) is the main window to switch. If you believe you have a may have access to event, contact Medicare or your plan to ask.
What if my doctor leaves my Part C plan's network?
If your doctor leaves the network mid-year, the plan must give you notice and usually allows you to switch to a different Part C plan or return to Original Medicare outside the normal open enrollment window. Contact your plan when ready if this happens to you.