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 sold by private health insurance companies. These plans may also provide additional benefits that Original Medicare does not.

If you’re considering purchasing a Medicare Part C plan, or you are wondering, “What is Medicare Part C?” read the article below to have your questions answered.

Enter your ZIP code into our free quote comparison tool above to find health insurance or a supplemental Medicare plan from companies in your area.

What is Medicare Part C?

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). Medicare Advantage plans may also provide additional 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.

What does Medicare Part C cover?

Medicare Part C must cover everything that Medicare Part A and Part B covers, 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.

How much does Medicare Part C cost?

About 65% of Medicare Advantage policyholders pay no premium for their plan other than the Medicare Part B premium (starting at $170.10 per month in 2022). 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.

What are 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).

Where can I get a Medicare Part C plan?

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 with Medicare Part C plans comparison tables.

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.