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

Part C, also called Medicare Advantage, is a plan sold by private insurance companies that bundles your Part A (hospital) and Part B (medical) coverage into one plan. Instead of getting coverage directly from Medicare, you sign up with an insurance company, and that company becomes responsible for paying your hospital and doctor bills. You still pay the same Medicare payroll taxes you always have — Part C is just a different way to receive the same basic coverage.

The main trade-off is this: Medicare Advantage plans often have lower monthly premiums and may include extras like dental or vision coverage that Original Medicare does not. In return, you usually have a smaller network of doctors and hospitals you can use, and you may pay more when you need care — through copays, coinsurance, or deductibles — than you would under Original Medicare.

Part C is optional. You can choose Original Medicare (Part A and Part B) instead, or you can switch between them during certain times of the year. The choice depends on your health, your doctors, and how much out-of-pocket cost you can handle.

Key Takeaways

  • Part C bundles hospital and medical coverage into one private insurance plan, so you have one card and one company handling your claims instead of two separate Medicare programs.
  • Most Part C plans include prescription drug coverage (Part D) and extras like dental or vision, which Original Medicare does not cover.
  • Part C plans have networks — you usually pay less if you see doctors and use hospitals within the plan's network, and more or nothing if you go out of network.
  • You can switch to or from Part C during the Annual Enrollment Period (October 15 to December 7 each year) or if you have a may have access to life event.
  • You still pay the Part B premium to Medicare each month, plus whatever monthly premium the Part C plan charges.

How Part C plans work differently from Original Medicare

Under Original Medicare, you see any doctor or hospital that accepts Medicare, and Medicare pays the bills. Under Part C, the insurance company you choose sets the rules: which doctors you can see, which hospitals you can use, and how much you pay for each visit.

Most Part C plans use a network model. If you see a doctor in the plan's network, you pay a copay (a fixed amount like $20 or $30) or coinsurance (a percentage of the cost). If you see a doctor outside the network, you may pay the full cost yourself, or the plan may not cover it at all — it depends on the plan. Some plans allow you to see out-of-network doctors but charge you more.

Part C plans also set an annual out-of-pocket maximum. Once you have paid that amount in copays and coinsurance in a calendar year, the plan pays 100 percent of your covered costs for the rest of that year. Original Medicare does not have this cap, which can be an advantage or disadvantage depending on how much care you need.

What Part C plans typically include

All Part C plans must cover everything that Original Medicare covers — hospital stays, doctor visits, and emergency care. But most plans add extras that Original Medicare does not. These commonly include prescription drug coverage, dental care (cleanings and exams, sometimes fillings), vision care (eye exams and glasses or contacts), and hearing aids or hearing exams. Some plans also cover fitness programs, transportation to medical appointments, or over-the-counter health items.

The catch is that these extras are not free. You may have a copay for a dental cleaning, a limit on how many vision exams you get per year, or a cap on how much the plan will pay for hearing aids. Read the plan's details before you sign up to understand what is actually covered and what you will pay.

Prescription drug coverage is included in most Part C plans, so you do not need to buy a separate Part D plan. If your Part C plan does not include drug coverage, you can buy Part D separately.

Costs you will pay with Part C

Part C costs vary by plan and by where you live. You will pay:

  • Your Part B premium to Medicare each month (the standard amount is deducted from your Social Security check unless you chose to pay it yourself).
  • A monthly premium to the insurance company, which may be $0 to $200 or more, depending on the plan and your location.
  • Copays or coinsurance when you see a doctor or use a hospital — for example, $20 for a doctor visit or 20 percent of the cost of an outpatient surgery.
  • An annual deductible before the plan starts paying, which varies by plan.

Some Part C plans have a $0 monthly premium, which sounds appealing, but they may have higher copays or deductibles. Others charge a higher premium but have lower out-of-pocket costs. Compare the total cost — premium plus expected copays — not just the premium alone.

When you can sign up for or change Part C

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

You can also switch to Part C if 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. You have 60 days from the event to make the change.

If you are in a Part C plan and want to switch back to Original Medicare, you can do so during the Annual Enrollment Period. You can also switch during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year — during this window, you can change to a different Part C plan or go back to Original Medicare without a penalty.

Questions to ask your doctor before choosing Part C

Before you sign up for a Part C plan, check whether your current doctors and hospitals are in the plan's network. Call your doctor's office and ask: "Are you in the [Plan Name] network?" If your main doctors are not in the network, you may want to choose a different plan or stick with Original Medicare.

Also ask your doctor about any specialists you see regularly. If you have a cardiologist or rheumatologist, make sure they are in the plan's network too. Switching doctors mid-year can be stressful, especially if you have a chronic condition.

If you take prescription medications, check the plan's formulary (the list of covered drugs) to make sure your medications are covered and at what cost. You can find formularies on the insurance company's website or by calling the plan directly.

When to contact Medicare or your plan

Contact Medicare (1-800-MEDICARE) if you want to understand the differences between Part C and Original Medicare, or if you are not sure which option is right for you. They can answer general questions and send you comparison materials.

Contact your Part C plan directly if you have questions about what is covered, what your copays are, or whether a specific doctor or hospital is in the network. You can find the plan's phone number on your insurance card or on the plan's website.

Seek when ready care if you have chest pain, difficulty breathing, sudden weakness, or other signs of a medical emergency. Call 911 or go to the nearest emergency room. Your Part C plan will cover emergency care even if you go to an out-of-network hospital.

Frequently Asked Questions

Can I use any doctor with Part C, or do I have to stay in a network?

Most Part C plans require you to use doctors and hospitals in their network to get the lowest cost. If you see an out-of-network provider, you may pay more or the plan may not cover it at all. Some plans allow out-of-network care at a higher cost. Check your plan's rules before scheduling an appointment with a doctor outside the network.

Do I still have to pay Part B premiums if I choose Part C?

Yes. You pay your Part B premium to Medicare each month, plus whatever monthly premium your Part C plan charges. The Part B premium is usually taken from your Social Security check automatically.

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

Most Part C plans only cover care in a specific geographic area. If you move out of your plan's service area, your coverage ends. You can switch to a different Part C plan that covers your new location, or switch to Original Medicare. You have 60 days after you move to make the change.

Can I have Part C and a Medigap plan at the same time?

No. Medigap plans are designed to work with Original Medicare, not Part C. If you have Part C, you cannot buy a Medigap plan. If you switch from Part C to Original Medicare, you may be able to buy a Medigap plan, but rules vary by state and by how long you have been in Part C.

What is the difference between Part C and Part D?

Part C covers hospital and medical care. Part D covers prescription drugs. Most Part C plans include Part D coverage, so you do not need to buy a separate drug plan. If your Part C plan does not include drugs, you can buy Part D separately.