Medicare Part C is an insurance option for people who want extra coverage beyond what typical Medicare plans cover. You may know these known as Medicare Advantage, offering you a choice in your plan type, coverage, and costs.
Medicare Part C is a type of insurance option that offers traditional Medicare coverage plus more. It’s also known as Medicare Advantage.
Some Medicare Part C plans offer health coverage benefits such as gym memberships and transportation services.
In this article, we’ll explore everything that Medicare Part C covers and how much these plans may cost.
Medicare Part C plans are insurance plans offered by private insurance companies. These plans, otherwise known as Medicare Advantage 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 (SNPs)
- Medicare savings account (MSA) plans
Medicare Part C coverage
Most Medicare Part C plans cover:
- hospital costs
- medical costs
- prescription drugs
- dental care
- vision care
- hearing care
Some plans may even offer additional coverage for health-related perks, like gym memberships and meal delivery services after you’ve been released from a hospital.
Medicare Part C inpatient coverage
The inpatient coverage you’ll receive with Medicare Part C will at least match those of Medicare Part A. These services include:
- inpatient hospital care
- inpatient mental health services
- inpatient rehabilitation services
- hospice care
- limited home healthcare
- limited stays in a skilled nursing facility
Medicare Part C outpatient coverage
Again, your Part C plan must cover at least what you would get under Medicare Part B, which includes:
- doctor’s appointments, including specialists
- emergency ambulance transportation
- durable medical equipment like wheelchairs and home oxygen equipment
- emergency room care
- laboratory testing, such as blood tests and urinalysis
- occupational, physical, and speech therapy
- imaging tests, such as MRIs and X-rays
- mental health counseling
- vaccinations for flu, hepatitis B, and pneumococcal disease
Any additional coverage for these services will be outlined by the specific plan you choose. For example, some plans offer basic vision exams, while others include allowances for prescription eyeglasses or contact lenses.
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
- health deductible: $0
- drug deductible: $350
- in-network out-of-pocket max: $7,550
- primary doctor visit copay: $0
- specialist visit copay: $45
Atlanta, GA
One insurance company offers a PPO plan that costs:
- monthly premium: $0
- health deductible: $0
- drug deductible: $0
- in- and out-of-network out-of-pocket max: $11,300
- in-network primary doctor visit copay: $5
- in-network specialist visit copay: $35
Dallas, TX
One insurance company offers an HMO plan that costs:
- monthly premium: $0
- health deductible: $0
- drug deductible: $300
- in-network out-of-pocket max: $6,300
- primary doctor visit copay: $0
- specialist visit copay: $25
Chicago, IL
One insurance company offers an HMO Point-of-Service plan that costs:
- monthly premium: $0
- health deductible: $0
- drug deductible: $0
- in-network out-of-pocket max: $4,500
- in-network primary doctor visit copay: $0
- in-network specialist visit copay: $35
Los Angeles, CA
One insurance company offers an HMO plan that costs:
- monthly premium: $0
- health deductible: $0
- drug deductible: $0
- in-network out-of-pocket max: $2,550
- in-network primary doctor visit copay: $0-25
- in-network specialist visit copay: $0-40
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.
Medicare Part C might be a good option for you if you:
- already receive Medicare parts A and B and want additional coverage
- need prescription drug coverage
- would like coverage for yearly dental, vision, or hearing exams
- are interested in many types of coverage in one convenient plan
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