Medicare Advantage, or known as Medicare Part C, is a bundled Medicare plan offered by private insurance companies. These private companies work with Medicare and make sure they provide full benefits to all beneficiaries.
Part C plan includes benefits that traditional Medicare plans may not cover such as vision care and hearing. Most plans also include Medicare prescription drug coverage.
Medicare regularly pays a fixed amount for your health expenses to the insurance companies offering private Medicare advantage plans. These companies follow the rules set by Medicare that may change each year.
A variety of options to choose from when you opt for the Medicare Plan C:
- Special needs plans (SNP)
- Medicare medical savings account plans (MSA)
- Private fee-for-service plans (PFFS)
- Health maintenance organization plans (HMO)
- Preferred provider organization plans (PPO)
Medicare Part C covers:
Medicare Part C covers everything included in Part A and Part B and added benefits. Medicare Part C offers various cost-sharing amounts for individual care and home health care. Under the Medicare Advantage, your hospice care cost generally is covered by traditional Medicare.
Under Original Medicare, outpatient care is generally covered by Medicare Part B. Outpatient care includes medically necessary services and preventive services to prevent or detect disease. Medicare Part C covers the same benefits as Medicare Part B, including:
- Doctor visits (primary care doctor and specialists)
- Laboratory tests and X-rays
- Ambulance services in an emergency
- Both inpatient and outpatient mental health services
- Durable medical equipment such as walkers and wheelchairs
- Preventative tests and vaccines, including flu shots
- Physical therapy
- Occupational therapy
- Speech and language pathology
Medicare Part C may have different cost-sharing amounts than Original Medicare has.
Medicare Part C Eligibility
To enroll in Medicare part C a person needs to meet two eligibility conditions:
- Currently enrolled in Original Medicare both Parts A and B
- Reside where the insurance provider offers the coverage that they require.
- This plan is also available during its application or enrollment period.
Medicare Part C Enrollment
Medicare C enrollment period (IEP) starts 3 months before a person turns 65. During this period, a person may enroll in:
- Medicare Parts A and B
- Medicare Part C or Medicare Advantage
- Medicare Part D
Medicare Part C Costs
Various factors determine the Medicare Part C costs, including deductibles, copayments, premiums, and coinsurance. This amount ranges from $0 to hundreds of dollars for monthly premiums and yearly deductibles
There are also various costs associated with Medicare Part C plans, including:
- Monthly plan premium
- Coinsurance
- Drug deductibles
- Part B
- In-network requirements
- Co-pays
Medicare Part C Premiums
About 60% of Medicare Advantage participants paid no additional premium in 2025.