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What is Medicare Part C (Medicare Advantage)? Coverage and Benefits
Medicare Part C provides an alternative to Original Medicare (Medicare Part A and Medicare Part B). Offered by private health insurance companies that are approved by Medicare, Medicare Part C plans—also known as Medicare Advantage plans—are legally required to offer at least the same benefits that are provided by Original Medicare, but may include additional routine coverage.
What does Medicare Part C cover?
Coverage Includes: Part A (hospital insurance), Part B (medical insurance), and often additional benefits like routine dental, vision, hearing, and Part D prescription drugs
What is Not Covered: Experimental procedures or out-of-network care (depending on the terms of your HMO/PPO plan)
The Cost of Medicare Part C: Is it free?
As mentioned above, Medicare Part C is an alternative to Original Medicare. Therefore, the same hospital and doctor benefits provided by Original Medicare are also provided by a Medicare Part C plan. Instead of paying deductibles and 20% of your medical services, you will pay the Medicare Part C plan copays. While you may find “zero-premium” Medicare Advantage plans, Medicare Part C is not completely free, as you must continue to pay your standard Medicare Part B premium.
Each Medicare Part C plan has a summary of benefits, which will list out various medical services and provide a summary that shows you what your copay or coinsurance will be for each service. Everything you spend on Part A and B services counts toward your out-of-pocket maximum. If you hit that maximum, your Part C plan will pay 100% after that for the rest of the year.
A SelectQuote licensed insurance agent can help check if low to $0/month premium plans are available in your zip code.
Who is eligible to receive Medicare Part C coverage?
Any Medicare beneficiary, regardless of age, can purchase a Medicare Part C plan if they meet the following criteria:
Enrolled in both Medicare Part A and B:
Some people mistakenly think they can drop Part B if they enroll in a Medicare Part C plan. However, if Part B is dropped, you will immediately lose your Part C plan, so it is important to keep both Parts A and B when enrolling in Medicare Part C.
Choose a Plan in the County You Reside:
Eligibility for Medicare Part C plans is based on the address you have on file with Social Security. You must choose a plan that operates in the county in which you live. Some plans will be specific to only one or two counties, while others might span the whole state.
Enrolling in or Switching to a Medicare Advantage Plan
There are specific windows throughout the year during which you may join, switch, or drop a Medicare Advantage plan. Learn about these timeframes below.
Initial Enrollment Period (IEP)
When you first become eligible for Medicare, you have a seven-month Initial Enrollment Period to sign up for a Medicare Advantage (Part C) plan. This includes the three months prior to your 65th birthday month, your birthday month, and the three months following your birthday month.
Important Note: You must first be enrolled in Original Medicare (Parts A and B) before you can choose a Part C plan.
Annual Enrollment Period (AEP)
The most common time to enroll in or switch a Medicare Part C plan is during the Annual Enrollment Period, which runs from October 15 to December 7 each year. During this window, you can:
Switch from Original Medicare to a Medicare Advantage plan
Switch from one Medicare Advantage plan to another
Drop your Medicare Advantage plan and return to Original Medicare. Changes made during AEP will take effect on January 1 of the following year.
Medicare Advantage Open Enrollment Period (MA OEP)
If you are already enrolled in a Medicare Advantage plan, you have an additional enrollment window from January 1 to March 31 each year. During this time, you can switch to a different Medicare Advantage plan or drop your current Part C plan and return to Original Medicare. You are only allowed to make one change during this period.
Special Enrollment Period (SEP)
You may be able to join, drop, or switch a Medicare Part C plan outside of the standard enrollment periods if you experience a qualifying life event. You may be eligible for a SEP if:
You move out of your current Medicare Advantage plan's service area
You lose other creditable coverage (like an employer or union health plan)
You qualify for Extra Help or Medicaid
Medicare ends your current Part C plan's contract
Learn More About Special Enrollment Periods
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