Medicare Part C (Medicare Advantage) is a bundled Medicare plan that incorporates hospital, medical, and prescription drug coverage for most people. It also covers additional services, such as dental, hearing, and vision care.
Medicare Advantage often provides more coverage than a traditional Medicare plan. However, people with this plan must choose from a network of doctors and providers or receive special permission to visit out-of-network doctors.
That said, receiving care outside of the network generally costs more.
Private health insurance companies administer Medicare Advantage. They must follow the rules that Medicare has established, as Medicare sends a fixed amount of money every month to fund an individual’s Advantage policy.
This article explains the details of Medicare Part C and how it differs from Original Medicare policies.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Health insurance companies offer thousands of Medicare Advantage plans. Their availability varies by region.
Types
Medicare Part C (Advantage) plans usually fall into one of five categories:
| Type of plan | Description |
|---|---|
| Health maintenance organization (HMO) | A person must receive care from a fixed network of healthcare providers. These doctors, clinics, and hospitals have agreed to provide discounted services to people who hold this plan. A person must often receive a referral from a primary care doctor for specialty medical care. If an individual receives care from an out-of-network provider, they may have to pay full price. |
| Preferred provider organization (PPO) | A person saves money by choosing in-network providers. However, a PPO organization may also fund a portion of care for an out-of-network provider. Treatment under these plans does not usually require a primary care provider’s referral. |
| Private free-for-services (PFFS) | People with PFFS plans have agreements with providers who accept Medicare. This agreement requires doctors to charge a specified amount for their medical services. Not all Medicare-approved providers accept these plans. Some PFFS plans may specify in-network doctors, while others do not. |
| Special needs plans (SNPs) | SNPs are plans that help those with specific chronic medical conditions. These people may use prescription medications and doctor services more regularly. Examples of medical conditions with SNPs include: • chronic heart failure • dementia • diabetes • end stage liver and kidney diseases • HIV All SNPs offer prescription drug coverage. |
| Medical savings account (MSA) | These plans combine a high-deductible insurance plan and a medical savings account. A person with this plan has a high deductible. They can use money from their MSA to help fund healthcare costs before needing to meet their deductible. This means that a person can fund medical expenses before insurance pays. Many MSA plans allow a person to seek care from any provider they choose |
Not every type of plan is available in all regions. As a general rule, areas with bigger populations have a greater variety of plans available.
It can be difficult to provide average costs for Medicare Part C, as a wide range of plans are available. Different personal circumstances, such as income and a history of paying Medicare taxes, also inform the cost of a policy.
A Medicare Advantage plan has its premium, which can sometimes be $0. The average monthly premium for 2024 is around $18.50. However, some monthly premiums can be $200 or more.
Each plan requires individuals to meet a specified deductible before their plan starts paying for healthcare services. For 2024, the maximum out-of-pocket spending is $8,850.
Read more about Medicare Advantage costs.
Eligibility for Medicare Part C plans depends upon the following criteria:
- Medicare Part A and B: To be eligible to sign up for Medicare Part C, a person must have both Part A and Part B plans already.
- Geographic area: Generally, Medicare Advantage plans have reduced availability in regions with a lower population, such as Alaska and Wyoming. People in larger cities often have the most plans available to them.
- Citizenship: A person must be a United States citizen or lawful resident to be eligible to sign up for any Medicare plan.
- Medical conditions: To qualify for a special needs plan, a person must have the medical condition the plan covers.
The Medicare website allows a person to search for available plans in their area by entering their zip code.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part C plans and Original Medicare policies vary in different ways.
| Original Medicare | Medicare Advantage (Part C) |
|---|---|
| includes Part A and Part B | bundled plans by Medicare-approved private companies that include Part A, Part B, and usually Part D |
| has the option for a separate drug coverage plan (Part D) | typically requires the use of in-network doctors |
| includes use of any doctor or hospital within the U.S. that accepts Medicare | may involve lower out-of-pocket costs |
| supplemental insurance (Medigap), employer coverage, or Medicaid can help pay out-of-pocket costs | may offer additional benefits, including: • vision • hearing • dental |
Learn more about Orginal Medicare vs. Medicare Advantage.
Medicare Part C (Medicare Advantage) is an alternative to Original Medicare. When a person chooses Medicare Advantage, they can select a plan that provides additional services Medicare does not cover, such as vision and dental.
Plan availability varies by geographic area, and a person must consider availability, coverage, and cost when selecting the best Medicare Advantage plan for them.