Medicare Part C(Medicare Advantage)
Many Medicare beneficiaries likely already know about Original Medicare: it combines Parts A and B, and is offered by Medicare through the federal government. However, there’s another option that millions of Americans choose each year: Medicare Part C, or Medicare Advantage.
Here, we’ll review what Medicare Part C entails, why people choose it, and how to find out if Medicare Advantage is the right plan for your needs.
What is Medicare Part C?
Medicare Part C, or Medicare Advantage, is an alternative way to receive your Medicare benefits. Instead of getting Part A (hospital) and Part B (medical) through the federal government, beneficiaries of Medicare Advantage receive benefits through a private insurance company that has been approved by Medicare.
These plans are required to cover everything that Original Medicare covers, but most go beyond that with extra benefits that vary depending on the plan.
In short, think of Medicare Part C as a health plan that combines your major medical needs into one streamlined package. Many people find it easier to manage and, in many cases, more affordable than juggling multiple plans.
What does Medicare Part C cover?
As we stated previously, every Medicare Advantage plan includes the same basic coverage as Original Medicare; where Medicare Advantage plans differ is that depending on the plan and insurance company that you choose, you have the opportunity to get extra benefits.
Here's what is covered by all Medicare Advantage plans:
What Does Medicare Part C Not Cover?
While the coverage offered by Medicare Advantage is extensive, there are still a few things that may not be included:
Out-of-Network Services: Many Medicare Advantage plans (especially HMOs) limit coverage to specific provider networks based on your location or the state you live in. Seeing a doctor outside of your network could mean higher costs, or no coverage at all.
Custodial Care: Long-term care in nursing homes or assisted living facilities is not covered by Medicare Advantage or Original Medicare.
Cosmetic Procedures: Surgeries or treatments performed solely for appearance are excluded.
Routine Foot Care or Alternative Therapies: Unless deemed medically necessary, services like routine podiatry, acupuncture, or massage aren't typically covered.
International Care: Most plans don't cover care received outside the U.S., though some plans may offer limited emergency coverage abroad.
Medicare Part C Eligibility
Because Medicare Advantage is offered by private insurance companies, it requires some additional prerequisites to qualify. To qualify for Medicare Advantage, you must:
Already be enrolled in Medicare Parts A and B. You need both hospital and medical coverage before joining Part C. This is because Medicare Advantage is simply a different way to receive your government-administered benefits via an insurance company that contracts with the federal government.
Live within the plan's service area. Medicare Advantage plans vary by ZIP code, so check that your preferred plan is offered where you live and includes all of your preferred providers and pharmacies.
Be a U.S. citizen or legal resident. You must have lived in the U.S. for at least five consecutive years in order to be eligible for Medicare Advantage.
Not have End-Stage Renal Disease (ESRD). This is typically the case, though some exceptions apply thanks to expanded coverage rules introduced in 2021.
Medicare Part C Costs
Because Medicare Advantage plans differ so widely depending on the insurance company, your location, and the extra benefits offered, it's difficult to nail down an estimated price for Medicare Part C.
That being said, when budgeting for Medicare Part C, be sure to consider your monthly premiums, deductibles, copays, and maximum out-of-pocket costs.
Medicare Part C Premiums
Most Medicare Advantage plans include a monthly premium (the amount varies by plan and location). Some plans charge an additional premium for enhanced benefits or prescription drug coverage. You are responsible to still pay your Part B premium, which is standardized by Medicare.
Part A premium is $0 for most people because they or a spouse have paid Medicare taxes long enough while working (generally for at least 10 years).
Medicare Part C Deductible
This is the amount you pay before your plan begins to cover costs. Deductibles can apply to both medical services (like doctor visits or lab tests) as well as prescription drugs (for plans that include Part D coverage).
Similar to premiums, Medicare Advantage deductible amounts vary widely, so check your plan's Evidence of Coverage to see how much you'll owe annually.
Medicare Part C Out-of-Pocket Costs
All Medicare Advantage plans have a set, annual out-of-pocket maximum, which is one of the major ways that Medicare Part C differs from Original Medicare (Original Medicare has no out-of-pocket maximum). Once you reach that cap, your plan then pays 100% of covered services for the rest of the year.
The federal government requires all Medicare Advantage plans to have an out-of-pocket spending cap; though the actual limit will likely differ between plans provided by different insurance companies, looking at maximums from previous years can give you an idea of what to expect; in 2025, the federal government-mandated out-of-pocket maximum was $9,350 for in-network services and $14,000 for plans that include out-of-network care.
How to Apply for Medicare Part C
Beneficiaries can sign up for Medicare Advantage online, over the phone, or through a licensed agent. That being said, Medicare Advantage is offered by many major insurance companies, meaning that there may be dozens of options available when it comes to the specific plan you choose.
The key with enrolling in Medicare Part C is to ensure your plan aligns with your medical needs, preferred doctors, and budget.
At Healthpilot, we make it simple. Answer a few quick questions about your health needs, and we'll help you find a plan that fits; no confusion, no pressure, and no extra cost.
When to Enroll in Medicare Part C
The enrollment periods for Medicare Advantage are a little more complicated than for Original Medicare. In general, here are the enrollment windows you should know:
| Enrollment Period | When it Takes Place | What You Can Do |
|---|---|---|
Initial Coverage Election Period (ICEP) | The 7-month window around your 65th birthday. | Sign up for Medicare Advantage. |
Annual Enrollment Period (AEP or Open Enrollment) | From October 15th to December 7th each year. | Switch, drop, or join a Medicare Advantage plan (changes take effect January 1st of the following year). |
Medicare Advantage Open Enrollment Period (MA OEP) | From January 1st to March 31st each year. | Switch to another Medicare Advantage plan or return to Original Medicare (if already enrolled in Medicare Advantage). |
Special Enrollment Periods (SEPs) | Happens outside of regular enrollment windows. | Depends on the reason for the issuance of the SEP. |
How to Enroll in Medicare Part C
You can enroll in Medicare Part C (Medicare Advantage) directly through a provider website, through Medicare.gov, or by using a Medicare plan finder tool like Healthpilot. With so many plan options available, it's smart to use a dedicated tool to research and compare your options before enrolling in a plan. Here's a quick step-by-step guide:
Check your eligibility for Medicare. Additionally, make sure you're already enrolled in Medicare Parts A and B.
Compare plans in your area. Use a trusted resource like Healthpilot to view plans side-by-side, including costs, coverage, and provider networks.
Review plan details carefully. Look at premiums, deductibles, out-of-pocket maximums, and if your prescriptions are covered.
Enroll online, by phone, or with help. You can enroll directly through Healthpilot, the Medicare.gov site, or by calling a licensed agent.
Watch for confirmation. Once you've enrolled, you'll receive your new Medicare Advantage card and coverage will begin on your effective date.
Learn More About Medicare
Medicare Part C FAQs
Medicare Part C is a version of Medicare coverage in the form of a plan from a private insurer.
It replaces Original Medicare (Parts A and B) by combining hospital (Part A), medical (Part B) benefits, and often prescription drugs (Part D) into one plan. There are also plans available that offer extra benefits.
Costs for Medicare Advantage plans vary by plan and location. Some plans charge more for extra benefits.
Whatever your Medicare Advantage premium is, it's important to keep the following in mind when budgeting for healthcare expenses:
- You'll always pay your Part B premium, even with a Medicare Advantage plan.
- Don't forget to factor in deductibles, copays, and the plan's out-of-pocket maximum.
For many beneficiaries, Medicare Part C is a great healthcare option. To determine whether this is the case for you, consider aspects like bundled coverage, predictable costs, and, in some cases, extra benefits.
If you travel often or want nationwide provider freedom, you may prefer staying with Original Medicare plus Medigap.
Though Medicare Parts C and D are both part of the Medicare offering, they cover different components of healthcare:
- Medicare Part C (Medicare Advantage)plans are health plans offered by private insurance companies that provide all the benefits of Original Medicare (Parts A and B, plus additional coverage options that often include drug coverage.)
- Medicare Part Dis a standalone prescription drug coverage that can be added to Original Medicare (or some Medigap plans).
In short, if you are wondering whether you need to enroll in Part D in addition to Medicare Advantage, you likely do not; your Part C plan typically already includes prescriptions, meaning adding a Part D plan may be redundant. To ensure that this is the case, be sure to check your plan documentation or use a Medicare plan comparison tool like Healthpilot.