Medicare Part C Coverage: An Expert Guide (2023)

Medicare Part C is one of the four main parts of Medicare (Medicare Part A, Part B, Part C, and Part D) and is sold by private health insurance companies. Often, Medicare Part C covers additional benefits that original Medicare coverage does not. Many Americans see Medicare Part C costs nothing more than their Plan B premium, while others pay upwards of $60 per month.

Also called Medicare Advantage, Medicare Part C plans combine Parts A and B into one simple policy. Many Medicare Advantage plans offer the possibility of additional coverage, like Medicare Part C dental coverage and vision insurance.

Read on to learn more about Medicare Part C coverage, including what it covers and how much it might cost. Then, compare rates and plans with multiple companies to find the right coverage for you.

Medicare Part C Explained

What is Medicare Part C and D? Medicare Part C is also known as Medicare Advantage. These plans are purchased from private health insurance companies approved by Medicare.

Medicare Part D is prescription drug coverage, which is generally included in Medicare Part C plans. Medicare Part C also includes Medicare Part A (inpatient care) and Medicare Part B (outpatient care).  In addition, Medicare Advantage plans may also provide extra coverage, such as vision or dental.

The Medicare program sets rules and guidelines that private health insurance companies must follow when they offer Medicare Advantage plans.

However, the companies have the freedom to set your out-of-pocket costs and rules for how to get services, such as needing a referral.

To meet the Medicare Part C eligibility requirements, you must live in the service area for a specific plan, have Medicare Part A and Part B, and be a lawful resident or citizen of the United States.

Medicare Part C Coverage

Medicare Part C coverage must have everything that Medicare Part A and Part B cover, including:

• Inpatient hospital care
• Skilled nursing facility (SNF) care
• Emergency care
• Doctor’s visits
• Preventative care
• Durable medical equipment (DME)

About 90% of Medicare Advantage plans also include Medicare Part D, which covers most prescription drugs. In addition, some plans will offer higher coverage than original Medicare and provide additional benefits, such as vision, hearing, dental, or health and wellness programs.

Recently, private health insurance companies have been approved to offer more benefits, such as adult daycare, in-home support services, and safety modifications like wheelchair ramps.

While Part C can cover extra services, it might not cover everything. If you’re looking for even more Medicare supplemental coverage, a Medigap insurance plan might be right for you.

Read more: What does health insurance cover?

Medicare Part C Coverage Costs

About 65% of Medicare Advantage policyholders pay no premium for their plan other than the Medicare Part B premium (starting at $164.90 per month in 2023). About 15% of policyholders pay at least $50 per month in addition to the Medicare Part B premium.

Of the policyholders who have to pay a premium on top of the Medicare Part B premium, the average cost is $60 per month. (If you include the policyholders who do not have to pay a premium, this drops the average cost down to $21 per month.)

Some companies will also help pay for Medicare Part B, so you may even pay less than the standard premium. The health insurance company is also responsible for setting the deductible cost, coinsurance, and copayments.

Medicare Part C Networks

Medicare Advantage plans are organized into networks containing various types of facilities and health care providers to ensure that you have access to the care you need.

Around 62% of Medicare Advantage enrollees belong to health maintenance organizations (HMOs). An HMO will only cover costs for in-network providers unless you need medically necessary emergency care from an out-of-network provider.

Around 36% of Medicare Advantage enrollees belong to preferred provider organizations (PPOs). PPOs will cover costs for in-network and out-of-network providers, but your out-of-pocket costs will be more expensive for out-of-network care.

A small percentage of Medicare Advantage plans are private fee-for-service (PFFS) plans, Medicare medical savings account (MSA) plans, or special needs plans (SNPs).

How to Get Medicare Part C Coverage

You can begin searching for Medicare Part C plans by using Medicare’s plan finder. The search should make it easy to understand the details of each plan and compare plans.

You should be able to find plenty of information on plans online. You can visit each company’s website to see if it’s possible to enroll in the plan online. If it’s not possible, you can fill out and send in an enrollment form for the plan of your choice.

If you need further help, you can also call Medicare at (800) 633-4227 (TTY: (877) 486-2048).

When you’re ready to enroll in a plan, you will need to provide your Medicare number and the date that your Medicare Part A and Part B coverage began. You should be able to find this information on your Medicare card.

Keep in mind that plan providers cannot call you to enroll you in a plan unless you ask them to. They also can’t ask you for financial information over the phone. So be careful about which personal information you provide.

If you need help finding affordable health insurance or a supplemental Medicare plan, enter your ZIP code into our free quote comparison tool below.

Case Studies: Medicare Part C Coverage

Case Study 1: WellCare Advantage Plan – Mary’s Journey to Affordable Healthcare

Mary, a 68-year-old retiree, was concerned about the rising costs of healthcare. After research, she enrolled in the WellCare Advantage Plan offered by WellCare Health Insurance Company. This Medicare Part C plan provided comprehensive coverage, including prescription drugs, dental, and vision services.

Case Study 2: Humana Gold Plus – John’s Experience With Extra Benefits

John, a 72-year-old retiree, enrolled in the Humana Gold Plus plan offered by Humana Insurance Company. In addition to standard Medicare Part C coverage, this plan provided extra benefits, including gym membership and a 24/7 nurse helpline. The gym membership motivated John to stay active and maintain his physical well-being, making it particularly helpful for him.

Additionally, having access to a nurse helpline gave him peace of mind, knowing that he could seek medical advice anytime. John’s experience with Humana Gold Plus highlighted the importance of considering the extra benefits offered by Medicare Part C plans when choosing insurance coverage.

Case Study 3: UnitedHealthcare Medicare Advantage – Sarah’s Journey to Personalized Care

Sarah, a 65-year-old retiree, had specific healthcare needs and wanted a plan that offered personalized care options. She opted for UnitedHealthcare Medicare Advantage, provided by UnitedHealthcare Insurance Company. This Medicare Part C plan allowed Sarah to choose her primary care doctor and provided coordinated care through a network of healthcare professionals.

Sarah valued the personalized approach, as it ensured continuity of care and helped her build a strong doctor-patient relationship. The UnitedHealthcare Medicare Advantage plan’s emphasis on personalized care allowed Sarah to receive the attention and medical expertise tailored to her individual health needs.