Medicare Part C is a type of insurance option that offers traditional Medicare coverage plus more. It’s also known as Medicare Advantage.

what medicare part c covers

Most Medicare Part C plans cover:

  • hospital costs
  • medical costs
  • prescription drugs
  • dental care
  • vision care
  • hearing care

Some Medicare Part C plans also offer additional health coverage benefits, such as gym memberships and transportation services.

In this article, we’ll explore everything that Medicare Part C covers, including why you may want Medicare Part C and how much it may cost.

Medicare Part C plans are insurance plans offered by private insurance companies. These plans, otherwise known as Medicare Advantage plans or MA plans, provide the same coverage as Original Medicare with the benefit of supplemental coverage.

If you already receive Medicare Part A and Part B, you’re eligible for Medicare Part C.

Medicare Part C plans follow traditional insurance structures and include:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-For-Service (PFFS) plans
  • Special Needs Plans (SNP)
  • Medicare Medical Savings Account (MSA) plans

Medicare Part C might be a good option for you if:

  • you already receive Medicare parts A and B and want additional coverage
  • you need prescription drug coverage
  • you’re interested in coverage for yearly dental, vision, or hearing exams
  • you’re interested in many types of coverage in one convenient plan

What exactly does Medicare Part C cover?

Medicare Part C covers what both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) cover.

Most Medicare Part C plans also offer prescription drug, dental, vision, and hearing coverage. Some plans may even offer additional coverage for health-related perks, like gym memberships and meal delivery services.

In addition, Medicare Part C plans come in a variety of structures that give people the freedom to choose what type of plan they want.

For example, some people with chronic health conditions may require a Medicare Part C SNP to help cover the costs of office visits, medications, and procedures. Other people may prefer a Medicare Part C PPO or PFFS plan to have more provider freedom.

The cost of a Medicare Part C plan will depend on a variety of factors. The most common costs within your plan will be:

  • your Part B monthly premium, which may be covered by your Part C plan
  • your Medicare Part C costs, which include a deductible and monthly premiums
  • your out-of-pocket costs, which include copayments and coinsurance

Below are some cost comparisons for Medicare Part C plans in some major cities around the United States. All the plans listed below cover prescription drugs, vision, dental, hearing, and fitness benefits. However, they all differ in cost.

New York, NY

One insurance company offers an HMO plan that costs:

  • monthly premium: $0
  • Part B premium: $135.50
  • in-network yearly deductible: $0
  • drug deductible: $95
  • in-network out-of-pocket max: $6,200
  • copays/coinsurance: $25 per specialist visit

Atlanta, GA

One insurance company offers a PPO plan that costs:

  • monthly premium: $0
  • Part B premium: $135.50
  • in-network yearly deductible: $0
  • drug deductible: $75
  • in- and out-of-network out-of-pocket max: $10,000
  • copays/coinsurance: $5 per PCP and $40 per specialist visit

Dallas, TX

One insurance company offers an HMO plan that costs:

  • monthly premium: $0
  • Part B premium: $135.50
  • in-network yearly deductible: $0
  • drug deductible: $200
  • in-network out-of-pocket max: $5,200
  • copays/coinsurance: $20 per specialist visit

Chicago, IL

One insurance company offers an HMO Point of Service plan that costs:

  • monthly premium: $0
  • Part B premium: $135.50
  • in-network yearly deductible: $0
  • drug deductible: $0
  • in-network out-of-pocket max: $3,400
  • copays/coinsurance: $8 per PCP and $45 per specialist visit

Los Angeles, CA

One insurance company offers an HMO plan that costs:

  • monthly premium: $0
  • Part B premium: $135.50
  • in-network yearly deductible: $0
  • drug deductible: $0
  • in-network out-of-pocket max: $999
  • copays/coinsurance: $0

It’s important to note that these price estimates were taken directly from Medicare.gov and don’t include any factors unique to your situation, such as how much your prescription drugs may cost or whether you receive financial assistance.

For a more accurate estimate of how much a Medicare Part C plan may cost you, check out the Find a Medicare 2020 Plan tool.

Medicare Part C provides an advantage over the other Medicare plans because it generally includes all the necessary coverages in one convenient plan.

The other Medicare plans include parts A, B, D, and Medigap. Medicare Part D and Medigap are meant to offer supplemental insurance to parts A and B.

Medicare Part A (hospital insurance)

Part A covers hospital visits, short-term nursing facility care, home health services, and hospice services. You’re required to have this coverage to be eligible for Medicare Part C.

Medicare Part B (medical insurance)

Part B covers prevention, diagnosis, and treatment of health conditions and mental illnesses. It also covers medical transportation costs. You’re required to have this coverage to be eligible for Medicare Part C.

Medicare Part D (prescription drug plan)

Part D is an add-on to Original Medicare (parts A and B) that can be used to cover the costs of prescription drugs. Prescription drug coverage is generally included in most Medicare Part C plans.

Supplemental insurance (Medigap)

Medigap is additional coverage for people who already have Medicare parts A and B. You don’t need Medigap insurance if you receive Medicare Part C, as your plan will already cover what Medigap would.

You qualify for Medicare Part C if you’re 65 or older and have enrolled in Medicare parts A and B. You’re eligible to enroll 3 months before your 65th birthday up until 3 months after your 65th birthday.

To enroll in Medicare Part C, you must also be enrolled in Medicare parts A and B. You must also live in the coverage area for any Medicare Part C plan you select.

You may enroll at Medicare.gov.

helping a loved one enroll in medicare?

There are important factors that go into helping a family member choose a Medicare Part C plan. Here are a few questions to ask your loved one:

  1. How often will you need to visit the doctor or specialists? Most Medicare Part C plans charge for visiting specialists and out-of-network providers. Sometimes a plan may cost more up front in deductibles and premiums but can save money for people with chronic health conditions that require more doctor’s office visits.
  2. How much can you afford in out-of-pocket costs each year? Almost all Medicare plans, including Medicare Part C plans, will cost a certain amount of money each year. Consider the costs of the premium, deductible, out-of-pocket maximum, and copays.
  3. What type of coverage are you looking for? This can help you narrow down exactly what types of coverage to look for in a Part C plan. It can include things like prescription drugs, vision, dental, hearing, fitness, transportation, and more.
  4. What type of plan are you interested in? Medicare Part C plans are offered in different structures, so it’s important to know what structure your family member is interested in. Do they have a doctor they like? Would an HMO save money?

Once you’ve had this discussion with your family member, use the plan comparison tool to find the plans in your area that best fit their needs.

You can compare costs and then call those companies to find out more on exactly what they can offer your loved one.

Medicare Part C is an insurance option for people who want more Medicare coverage. Also known as Medicare Advantage plans, Part C plans give you the opportunity to choose your plan type, coverage, and costs.

You may want a Medicare Part C plan if you:

  • take prescription drugs
  • require dental, vision, or hearing coverage
  • enjoy additional health benefits like fitness and medical transportation

In many larger U.S. cities, Medicare Part C plans start from $1,500 and increase in cost from there.

If you’re helping a loved one choose a Medicare Part C plan, be sure to sit down and discuss their individual healthcare needs to help them find the plan that provides the most benefit.