What is Medicare Part C and what does it cover?
Medicare Advantage plans, or Medicare Part C plans, are comprehensive plans that include the same benefits of Medicare Parts A and B plus additional coverage. That’s important if you need more than what Original Medicare provides.
What does Medicare Part C cover?
Medicare Advantage (Part C) has more coverage for routine healthcare that you use every day.
Medicare Advantage plans may include:
- Routine dental care including X-rays, exams, and dentures
- Vision care including glasses and contacts
- Hearing care including testing and hearing aids
- Wellness programs and fitness center memberships
What does Medicare Part C cover compared to Original Medicare?
Medicare Part C plans cover Part A and Part B, and many also include prescription drug coverage (Part D) and other benefits not available with Original Medicare. That’s why, of the approximately 64 million people who applied for Medicare, nearly 22 million of them opted for Medicare Advantage plans.1
Original Medicare includes Part A and Part B. Part A covers hospitalization, home care, and other inpatient medical needs. Part B covers outpatient care such as doctor visits, medical tests, screenings, and preventive care.
Many people may need more coverage for their health needs. For example, Original Medicare doesn’t have prescription drug coverage. Private insurers offer Medicare Part D coverage, but even then, there still may be areas of your healthcare where you need protection. That’s where Medicare Part C plans come in.
What are Medicare Part C (Medicare Advantage) costs?
It’s pretty easy to find a Medicare Advantage plan that fits your budget. Medicare Part C premiums, deductibles, and copays vary from plan to plan and state to state. Empire has many options, and there are money-saving programs for those with low incomes.
Medicare Advantage plans also cap your out-of-pocket costs for Part C covered services. Once you reach the cap, you pay nothing for the rest of the year. That’s one of the added benefits of Medicare Part C.
Should I enroll in a Medicare Advantage plan?
| Pros of Medicare Part C | Cons of Medicare Part C |
|---|---|
| Provides coverage for services not covered by Original Medicare | You may have two premiums, Medicare Part B and Medicare Part C |
| Most Medicare Part C plans offer prescription drug coverage (Part D) | Your network of healthcare providers may be smaller |
| Caps out-of-pocket expenses | Can’t be used with employer-sponsored healthcare benefits that supplement Original Medicare |
If you decide to review Medicare Advantage plan options, here are some key questions to keep in mind:
Are your preferred hospitals or preferred doctors included in a Medicare Advantage plan?
Providers can change yearly, so it’s best to make sure your family doctor is still in the plan after your initial enrollment. Just ask when you go for a doctor visit.
What prescription drugs are covered?
You can use our find-a-drug tool to check what drugs are available in the plan. If you need medications, you can find out if they are available and affordable under a selected plan.
What are the maximum out-of-pocket costs?
Weigh your budget with coverage to find a plan that fits your needs. A lower out-of-pocket maximum may be preferable so you have peace-of-mind protection for unexpected injuries or illnesses.
How to enroll in a Medicare Part C plan
If you are applying for Medicare for the first time, you can choose a Medicare Advantage plan during the Initial Enrollment Period (IEP). This is the seven-month period that includes:
- Three months before your 65th birthday
- Your 65th birthday month
- Three months after your 65th birthday
If you’re already enrolled in Original Medicare, you can change to a Medicare Advantage (Part C) plan during the Medicare Annual Enrollment Period (AEP), which is October 15 to December 7. If you’re already enrolled in a Medicare Advantage plan, you can switch to a different one during this time.
You also have a chance to change your Medicare Advantage plan from January 1 to March 31 during the Medicare Advantage Open Enrollment Period.
What is the difference between Medicare Part C and Part D?
Medicare Part C provides more coverage for everyday healthcare including prescription drug coverage with some plans when combined with Part D. A Medicare Advantage prescription drug (MAPD) plan is when a Part C and Part D plan are combined.
Medicare Part D only covers prescription drugs. If you have Original Medicare and just need a plan for prescription medications, Medicare Part D is the best choice. When you require more coverage for dental, vision, or prescription drugs, Medicare Part C plans provide more options to fit your healthcare needs.
1 https://www.kff.org/medicare/fact-sheet/medicare-advantage/
