What is Medicare Part C?

Medicare is a health insurance program designed for individuals age 65 or older, but individuals younger than 65 may also qualify for benefits under certain circumstances. This health insurance program offers a range of medical services, but not all services are free. If you are eligible for Medicare but require extra coverage for drugs and services, Medicare Part C may be a good option.

Medicare Part C, also known as Medicare Advantage plan, is a Medicare plan that provides all the services you would receive under Medicare Part A and B, plus additional coverage. The additional coverage offered by Medicare Part C includes vision, hearing care, dental, gym membership, and wellness programs. It is offered through private health insurance companies approved by Medicare.

Parts of Medicare Coverage

Medicare is available to seniors age 65 or older, and it helps cover healthcare costs for beneficiaries. For most people, Medicare eligibility begins three months before turning 65 and ends three months after turning 65.

If you are already collecting Social Security benefits, Social Security will automatically enroll you into the Original Medicare i.e. Medicare Part A and Part B. Medicare Part A pays for inpatient care in a hospital or limited time in a skilled nursing facility after a hospital stay. Medicare Part B pays for services from doctors and other healthcare professionals, outpatient care, home health care, and durable medical equipment.

People who are eligible for Original Medicare can purchase extra coverage for drugs and services such as doctor visits through private health insurance companies. However, the additional coverage follows the rules set by Medicare. The additional coverage includes Medicare Part C, Medicare Part D, and Supplemental policies (Medicap).

What is Medicare Part C?

You qualify for Medicare Part C plan if you have enrolled for Medicare Part A and Part B, and the coverage includes the same benefits as Medicare Parts A and B, plus extra coverage such as dental care, vision care, hearing care, and wellness programs.

Medicare Part C is offered through private insurance companies, and it provides coverage that is as good as Original Medicare. The federal government requires these plans to cover everything that the Original Medicare covers, and some private insurance providers may opt to pay for healthcare services that Medicare Part A and B do not cover.

Medicare Part C plans are allowed to cover extras like meal delivery, wheelchair ramps, and transportation to and from doctor’s offices. However, Medicare Part C plans do not offer similar benefits, and you review the plan description to know which services you will receive.

What does Medicare part C cover?

Medicare Part C offers at least similar basic health services that are offered under the original Medicare. Some of these basic services may include:

Inpatient hospital stays

Doctor’s visits

Limited stays at a skilled nursing facility

Inpatient rehabilitation

Limited home healthcare

Mental health services

Durable medical equipment

Laboratory tests

Hospice care

Medicare Part C may also offer additional services including:

Vision care

Dental care

Hearing care (including hearing aids)

Prescription drugs

Gym membership

Wellness programs

Home meal delivery

What are Medicare Part C costs?

There are various costs that you will incur when you enroll for a Medicare Part C plan, and these costs vary across plans. These costs comprise premiums, deductibles, copayments, and coinsurance, and they can range from $0 to several hundred dollars in monthly premiums. Part C plans cap the out-of-pocket costs for covered services, and once you reach the cap, you won’t pay any extra costs for the year.

Premiums are the costs you pay every month out-of-pocket for Medicare Part C. The estimated average monthly premium for 2023 is $18, but the price could be as low as $0 and go as high as over $200. If the cost is zero, it means you won't pay a monthly premium, but you may still owe the Medicare Part B premium.

Most Medicare Part C plans also have a plan deductible and a drug deductible. A deductible is an out-of-pocket cost that you pay before the benefits start. Most of the $0 premium Part C plans offer a $0 plan deductible, but plans that include prescription drug coverage have an extra deductible for drug coverage.                  

You may also be required to pay a portion of the costs for covered drugs or services. These costs are known as copayments and are paid as a flat fee for the covered service or drugs such as doctor’s visits or prescription drug refills. You may also pay co-insurance, which is the percentage of services you must pay out-of-pocket after the deductions have been met.

The out-of-pocket costs vary in each Medicare Part C plan, and they vary each year. However, the maximum out-of-pocket spending is capped at $8,300 for 2023. If your plan includes prescription drug coverage, you will have a separate limit for out-of-pocket prescription drug costs.

How to enroll in Medicare Part C

If you are applying for Medicare health insurance for the first time, you can pick a Medicare Part C plan during the Initial Enrollment Period (IEP). For most people, the IEP happens three months before the 65^th birthday, on the 65^th birthday month, and three months after the 65^th birthday.

Sign up for Original Medicare through Social Security to get your Medicare card and Medicare number. Compare the available plans to find the options that suit your needs. You can then enroll for Medicare Part C through Medicare.gov or directly through a private insurance company.

Since Medicare plan availability and benefits change each year, you should review your coverage during the annual enrollment period to know if your benefits will change in the following year and if you are overpaying. You can call your Medicare Part C provider, visit their website, or visit your local Social Security office for information about Medicare plans and costs. If you are already enrolled in a Medicare Part C plan, you can switch to a different plan during the enrollment period.