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Medicare Part C (Medicare Advantage)

Summary: Medicare Part C is available from private insurance carriers and not only covers everything Original Medicare covers but may also come with additional benefits in certain areas. Also known as Medicare Advantage plans, benefits and plan availability can vary by location. For many, Part C plans are a great alternative but it’s important to weigh all of your options before enrolling. Estimated Read Time: 4 mins

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Table of Contents:

  1. What is Medicare Part C?
  2. What Medicare Part C Plans are Available?
  3. Pros and Cons of Medicare Part C
  4. What Is the Difference Between Medicare Part C and D?
  5. Is Medicare Part C the Same as a Medicare Supplement Plan?
  6. Is Medicare Part C the Same as Medicare Advantage?
  7. How to Enroll in Medicare Part C

Medicare Part C is health insurance coverage from a private insurance company that assumes your risk from Original Medicare. Also known as Medicare Advantage plans, this means that Medicare Part C becomes your primary source of coverage rather than Original Medicare (Part A and Part B).

While these policies may offer an array of benefits they also vary from carrier to carrier or from zip code to zip code. Below, we’re exploring how Medicare Part C can help you cover healthcare costs.

What is Medicare Part C?

Original Medicare is made up of Medicare Part A (hospital services) and Part B (outpatient services). Medicare Part C plans are all-in-one healthcare options that combine Original Medicare benefits plus additional coverage in some cases.

When you enroll in a Medicare Part C plan, the company you enroll with becomes your primary source of health insurance. Upon agreeing to pay your claims, your Part C Medicare plan receives funding from the government. Instead of the federal government paying your claims, it is the responsibility of your insurance company.

While Medicare Part C is not mandatory, some people choose the coverage instead of Original Medicare with or without a Medicare Supplement plan, also known as Medigap. Medicare Part C coverage must at least match Original Medicare coverage. However, since there are several Medicare Part C plan types, costs for enrollees can vary widely.

What Medicare Part C Plans are Available?

Medicare Part C plans are available through major health insurance companies as well as regional carriers depending on your location. Each carrier offers different plans with varying benefits. However, the most popular Medicare Part C plan types are health maintenance organization (HMO) and preferred provider organization (PPO) plans.

Thus, if you are looking for a plan with a wider availability of doctors and hospitals, you might need to look at PPO plans. If you are looking for a smaller network of providers, an HMO plan might be right for you. Often, PPO plans come at a higher cost because they allow more benefits than an HMO plan.

To know which plan types are right for you, it is important to research the available plans in your area to know what benefits work for your needs. Please note that regardless of your carrier, Medicare Advantage Part C plans must cover everything Original Medicare will cover.

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Pros and Cons of Medicare Part C

Part C Medicare coverage is an alternative to Original Medicare, but is it right for you? For many, the coverage is a great way to cover healthcare costs, but for others, it may not be the correct choice. To better understand if Part C is right for you, weigh the pros and cons below:

Pros Cons
May cover healthcare not covered by Original Medicare You pay both Part B and Part C premiums
Prescription drug coverage may be available Networks can limit healthcare access
A popular option that is right for many beneficiaries “Extra benefits” may feel misleading
You deal with a private company, not the government You can’t have both Medicare Part C and Medigap at the same time

What Is the Difference Between Medicare Part C and D?

The difference in Medicare Part C and Part D is how they cover your healthcare. Here’s how they differ:

  • Medicare Part C is an alternative to Original Medicare to cover your healthcare. Some plans may provide prescription drug coverage.
  • Medicare Part D covers prescription drugs but none of your other forms of healthcare. You can add Part D to your coverage if you have Original Medicare. This includes those who also have Medigap.

Is Medicare Part C the Same as a Medicare Supplement Plan?

No, Medicare Supplement plans pay secondary to Original Medicare to provide coverage for costs you would otherwise have to pay out-of-pocket. Medicare Part C plans assume your risk and become your primary coverage rather than Original Medicare.

Is Medicare Part C the Same as Medicare Advantage?

Medicare Part C is Medicare Advantage. While private plans began as early as 1966 through HMOs, Medicare Part C came to be through the Balanced Budget Act of 1997 (BBA). The name was officially called the Medicare+Choice program but the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) would rename it to Medicare Advantage.

How to Enroll in Medicare Part C

At MedicareFAQ, we help Medicare beneficiaries enroll in coverage every day. One of our licensed agents will explain the pros and cons of your Medicare Part C options and research all the top providers in your area. We help you compare your options for Medicare Part C and Medicare Supplement plans to find the right policy for your healthcare needs.

To reach a licensed insurance agent, give us a call at the number above. Can’t call now? No problem! Complete our online rate form to learn more about your Medicare Part C options in your area.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. What is Medicare Part C, HHS. Accessed April 2022.
    https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html
  2. How Do Medicare Advantage Plans Work, Medicare. Accessed April 2022.
    https://www.medicare.gov/sites/default/files/2018-07/11474.pdf
  3. Understanding Medicare Advantage, Medicare. Accessed April 2022.
    https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

14 thoughts on "Medicare Part C (Medicare Advantage)"

  1. My wife is on Medicare, retired, no major health issues. She has coverage through AARP. We are trying to find one that will give back the $148 taken from her check. Losing the $148 is a hardship. We live in Florida, where no Medicaid is to pay for the cost.

    1. Responding 2 years later because I landed on this page looking for plans in Jackson County Oregon. But when I lived in FL I had CarePlus and they gave back a sizable amount of the part B premium. It may have been reduced by almost 80% or thereabouts. To me when I was doing side by side comparisons, that was the most important feature of a plan. If they’re reducing it by lets say $140 your only paying about $35/mo or an annual $1680 savings (also had $0 deductibles, and $0 for other premiums)

  2. Hi, I am looking into medical benefits on behalf of a loved one. They have Rheumatoid Arthritis and require what most insurances classify as “specialty” medication. Due to this classification Medicare, and their supplemental plans will not cover the RX to a reasonable amount. By reasonable I mean typically affordable for an average individual. The base price of a months supply for the prescription in question is around 6,000 dollars. With their current plan my loved one would still end up paying over $1,500 a month for their medicine. Which is impossible when she is living off of $1,000 a month. My question is what kind of drug coverage can be found using an Advantage plan? Would it be worth it to have her look into this?

  3. will i still qualify for the part B give back option if i qualify for the extra help from medicare?

    1. If I 144% under poverty level l got a letter from extra help it says 50 % of symubsidy to help pay for monthly premiums what does that mean will they reduce my Medicare part b by 50% from my check please explain don’t undedstand

  4. Lindsay:

    We are located in California. How much does Medicare pay out for a Senior Citizen on their Medicare Advantage plan. Is it taken out of the Senior’s Social Security Benefit?

  5. Hi Lindsay,
    Can you tell me if a Medicare Advantage has the authority to request prior authorization for services covered under an NCD-CED?
    Thank you,
    Lori

  6. I have a question. Does medicine pay a premium for those using an advantage plan? My understanding is that Medicare pays a premium to insurance companies for administering advantage plans so the cost is higher then go conventional Medicare

    1. Hi Richard! Medicare does pay the Medicare Advantage carrier to take on your risk. However, you still must pay the monthly premium for Part B. Some Medicare Advantage plans come with a premium reduction benefit to help with this.

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