Medicare Part C plans are part of the Medicare Advantage program, which is offered by private companies approved by Medicare.
Medicare Advantage Plans cover all Part A (hospital) and Part B (medical) services from Original Medicare and most plans also include Part D prescription drug coverage.
A set payment from Medicare is made to companies offering Advantage Plans, and in return those companies must follow Medicare rules to keep participation. Plans may charge different out-of-pocket costs and can set rules about how services are obtained, for example whether a referral is required to see a specialist. Rules and plan details can change each year.
Summary of Medicare Advantage Plans
- HMO - Health Maintenance Organization
- PPO - Preferred Provider Organization
- PFFS - Private Fee for Service
- SNP - Special Needs Plan
Less common plan types
- HMO Point of Service (HMOPOS) - allows certain out-of-network services for a higher price.
- Medical Savings Account (MSA) - combines a high-deductible health plan with a bank account where Medicare deposits funds that can be used to pay services up to the deductible.
Costs of Medicare Advantage Plans
Costs of Medicare Advantage Plans.Many plans combine a monthly plan premium with the regular Part B premium into a single payment, but specific costs vary by plan.
- Whether the plan pays part or all of the Part B premium.
- Copayments or coinsurance amounts for services and visits.
- Whether the plan has an annual deductible or additional deductibles.
- The plan's annual out-of-pocket limit for medical services.
- Whether you need extra benefits the plan covers, such as vision or dental.
- Whether the plan charges a separate monthly premium.
- The types of services you need and how often you use them.
- Whether you follow plan rules, especially about network providers and prior authorizations.
What is covered.Medicare Advantage Plans must cover all services that Original Medicare covers, except hospice care, which Original Medicare continues to cover even if you are in a Medicare Advantage Plan.
In addition to prescription drug coverage, many Advantage Plans offer extra benefits such as vision, dental, hearing, and wellness programs.
Important considerations with Advantage Plans
Plan coverage generally begins on the first day of the month after your enrollment form arrives at the plan's office. During that period be cautious about switching plans or coverage types without confirming enrollment rules.
- Switching from Original Medicare to an Advantage Plan.
- Switching from one Medicare Prescription Drug Plan to another.
- Joining, dropping, or switching a Medicare Medical Savings Account Plan.
- Switching from one Medicare Advantage Plan to a different one.
Members in Advantage Plans retain the same rights and protections available under Original Medicare, including the right to appeal decisions. Always check with the plan before receiving care to confirm coverage and costs, and follow plan rules such as obtaining referrals or prior authorizations when required to avoid higher charges.
It is generally possible to join a Medicare Advantage Plan with a pre-existing condition, though individuals with end-stage renal disease may face special eligibility rules.
If a plan stops participating in Medicare, affected members must choose another plan or return to Original Medicare.
When comparing options, it helps to review local plan quality and enrollment information. For background on program basics, see Understanding Medicare and Medicaid.
How to enroll in a Medicare Advantage Plan.Because plans differ, take time to compare benefits, costs, and rules before joining.
Medicare provides tools and information to compare plans and enrollment details; for guidance on drug coverage and enrollment, see Understanding Medicare Part D and Enrollment.
Applications are usually accepted by mail, by phone, or through a plan sponsor's website; you can also talk to an agent for personalized help.
Frequently Asked Questions
Can a Medicare Advantage Plan charge more than Original Medicare?
Yes. Advantage Plans can set different copayments, coinsurance, and deductibles, so total out-of-pocket costs may differ from Original Medicare.
Does Medicare Advantage cover prescription drugs?
Many Medicare Advantage Plans include Part D prescription drug coverage, but not all do; check each plan's drug benefit details.
Are emergency and urgent care covered by Advantage Plans?
Yes, both emergency and urgent care are required to be covered by Medicare Advantage Plans.
What happens if my plan leaves Medicare?
If a plan ends Medicare participation, members must enroll in another plan or return to Original Medicare to maintain coverage.