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 bundles your hospital coverage (Part A), doctor visits (Part B), and usually prescription drug coverage (Part D) into one plan. You still pay your Part B premium to Medicare, but you choose a private insurer to deliver your benefits instead of using Original Medicare (Parts A and B separately).

The trade-off is that most Medicare Advantage plans have a smaller network of doctors and hospitals you can use, and you may pay more out of pocket when you see a doctor. In return, many plans charge no monthly premium beyond what you already pay Medicare, and they often include benefits Original Medicare does not — like dental, vision, or hearing coverage.

You do not have to choose Part C. You can stay with Original Medicare and buy a separate Medigap or Part D plan instead. Part C is one option among several.

Key Takeaways

  • Medicare Part C combines hospital, doctor, and usually drug coverage into one private insurance plan, but limits you to doctors and hospitals in that plan's network.
  • You still pay your Part B premium to Medicare each month, plus any copays or coinsurance the plan charges when you use care.
  • Many Part C plans include dental, vision, or hearing benefits that Original Medicare does not cover.
  • You can switch to or from Part C only during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event.
  • Part C plans vary widely by location, insurer, and year — the same plan may not be available next year or may change its network and costs.

How Part C differs from Original Medicare

Original Medicare is run by the federal government. You go to any doctor or hospital that accepts Medicare, and Medicare pays its share of the bill. You pay a deductible and coinsurance, and you can buy a Medigap policy to cover some of those costs.

Part C is run by a private company under contract with Medicare. The insurer decides which doctors and hospitals are in the plan, what you pay for each visit, and what services are covered. If you go to a doctor outside the network, you usually pay the full bill yourself — except in emergencies. The insurer must cover everything Original Medicare covers, but they can charge different amounts and require prior approval for some treatments.

One major difference: Part C plans have an out-of-pocket maximum. Once you spend a certain amount on copays and coinsurance in a year, the plan pays 100 percent of covered services for the rest of that year. Original Medicare has no out-of-pocket maximum, which is why many people buy Medigap.

What Part C plans typically cover

All Part C plans must cover everything Original Medicare covers: hospital stays, doctor visits, lab tests, imaging, and emergency care. Most plans also include prescription drug coverage (Part D) automatically, so you do not need to buy a separate drug plan.

Many plans add benefits Original Medicare does not pay for. Common extras include dental (cleanings, fillings, sometimes dentures), vision (eye exams, glasses or contacts), hearing (exams and hearing aids), and fitness programs. Some plans cover transportation to medical appointments or meal delivery after a hospital stay. The specific benefits vary by plan and location.

What Part C does not cover is the same as what Original Medicare does not cover: long-term care, dentures (unless your plan includes it), routine foot care, or cosmetic surgery. You would need a separate long-term care insurance policy for nursing home or home care costs.

Network restrictions and how they affect your choices

Each Part C plan has a network of doctors, hospitals, and specialists. If you use a provider in the network, you pay the plan's copay or coinsurance. If you use an out-of-network provider, you usually pay the full bill yourself.

Some plans are HMOs (Health Maintenance Organizations), which means you must use in-network providers except in emergencies. Others are PPOs (Preferred Provider Organizations), which let you see out-of-network doctors but charge you more. A few are PFFS (Private Fee-for-Service) plans, which work differently — the plan pays the provider directly, and you pay your share.

Before you choose a Part C plan, check whether your current doctors are in the network. If your doctor is not in the plan, you would have to switch doctors or pay out of pocket. Plans change their networks every year, so a doctor who was in the plan last year might not be this year.

Costs you pay with Part C

You pay three types of costs with Part C. First, you still pay your Part B premium to Medicare each month (the amount changes yearly). Second, many plans charge a monthly premium on top of that, though some plans have zero premium. Third, you pay copays or coinsurance when you use care — for example, $15 to see your primary doctor or $250 for a hospital stay.

The copays and coinsurance vary by plan. One plan might charge $10 per doctor visit and another might charge $30. You need to compare the plans available in your area to see which one fits your budget and the doctors you use.

Part C plans have an out-of-pocket maximum, usually between $5,000 and $7,000 per year, though the exact amount varies. Once you hit that limit, the plan pays 100 percent of covered services for the rest of the calendar year. This is different from Original Medicare, which has no limit.

When you can enroll in or switch Part C plans

You can join a Part C plan when you first become may be able to access for Medicare (usually at age 65). After that, you can only change plans during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Any changes you make take effect January 1.

If you have a may have access to life event — such as moving to a new state, losing employer coverage, or getting married — you may be able to switch plans outside the enrollment period. You must report the change to Medicare within 60 days of the event.

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 (January 1 to March 31), but only to a different Part C plan or back to Original Medicare — you cannot switch to a different type of plan.

Questions to ask your doctor and your plan

Before you choose a Part C plan, contact your current doctors and ask whether they are in the plan's network. Ask whether they accept the plan's payment terms and whether they require prior approval for any treatments you currently receive.

Call the plan directly and ask: What is the monthly premium? What are the copays for my doctor and the specialists I see? Is my pharmacy in the plan's network? What prescription drugs are covered? Do I need prior approval for any of my current medications? What is the out-of-pocket maximum?

Ask your plan about appeal rights if they deny a treatment you think you need. Ask whether the plan covers care outside the network in emergencies, and what counts as an emergency.

When to seek help or more information

You can compare Part C plans in your area on Medicare.gov. You can also call 1-800-MEDICARE to speak with a counselor who can answer questions about your options.

If you are already in a Part C plan and your doctor leaves the network, or if the plan changes its coverage in a way that affects you, contact the plan when ready. Ask whether you can continue seeing that doctor or whether you have other options. You may be able to request an exception to the network rules.

If you think a Part C plan wrongly denied a service or medication, you have the right to file an appeal. The plan must tell you how to appeal in writing, and you can also ask for help from your State Health Insurance information Program (SHIP), which offers free counseling.

Frequently Asked Questions

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

No. If you are in a Part C plan, you cannot buy a Medigap policy. Medigap is designed to work with Original Medicare. However, Part C plans often include benefits like dental and vision that Medigap does not, so you may not need Medigap.

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

Your current plan may not be available in your new state. When you move, you have 60 days to choose a new plan. Contact Medicare or your current plan to find out what options are available where you are moving.

Do Part C plans cover care outside the United States?

Most Part C plans do not cover routine care outside the U.S., though they may cover emergency care. Check your plan's coverage rules before traveling. Some plans offer limited coverage in Mexico and Canada.

Can I switch from Part C back to Original Medicare anytime I want?

You can switch during the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). If you have a may have access to life event, you may be able to switch outside these windows.

What if my Part C plan goes out of business?

Medicare requires plans to notify you at least 30 days in advance if they are leaving your area. You will be able to switch to another Part C plan or back to Original Medicare without waiting for the enrollment period.