What Is Medicare Part C and What Does It Cover?

Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare. It's provided by private insurance companies that Medicare approves. Medicare Part C covers Medicare Parts A, B and sometimes D.

Medicare Part C often offers extra benefits like vision and dental care. To be eligible, you need to enroll in Medicare Parts A and B, be a US citizen or resident and meet age or disability rules. There are specific times during the year when you can enroll or make changes to your plan.

• What Is Medicare Part C?
• What Part C Covers
• What Part C Does Not Cover?
• Who Is Eligible
• Different Part C Plan Types
• Medicare Part C FAQ

Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare offered through private insurance companies that are approved by Medicare.

Part C plans bundle together different parts of Medicare, including Medicare Part A (hospital insurance), Part B (medical insurance) and usually Part D (prescription drug coverage). They often also include additional benefits not covered by Original Medicare, such as vision, dental and hearing services​.

Medicare C plans must follow Medicare's regulations but can set their own rules on accessing services. For instance, some plans might require referrals to see specialists or impose limitations on which health care providers you can see, usually requiring you to stay within the plan’s network except in emergencies.

This can affect your out-of-pocket costs and how you get medical services, which can vary from plan to plan.

Medicare Part C is a comprehensive health plan that provides the following benefits:

• Hospital Insurance or Part A: Typically provides coverage for hospital stays, care in skilled nursing facilities and certain home health services.

• Medical Insurance or Part B: Includes services from doctors and other health providers, outpatient care, home health care, durable medical equipment and preventive services like screenings and vaccines.

• Prescription Drug Coverage (Part D): Most Part C plans include this, providing essential medication coverage.

For some specific plan types, like Medical Savings Account (MSA) Plans or certain Private Fee-for-Service Plans that don’t include Part D, you're allowed to join a separate drug plan. On the other hand, if you're enrolled in a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan that doesn’t include drug coverage, you cannot join a separate Medicare drug plan.

Additional benefits often included:

• Eye Care: Yearly exams, allowances for lenses, frames, and contacts, diabetic eye exams and glaucoma screening.

• Dental Care: Includes check-ups, cleanings, dentures and crowns

• Hearing Care: Coverage for exams and hearing aids

• Wellness Programs: Includes gym memberships or discounts and wellness services

• Transportation: Assistance getting to and from medical appointments

• Over-the-Counter Medications: Certain plans provide allowances for these items

• Meal Delivery: Available after hospital stays for recovery support

Medicare Advantage plans also cap annual out-of-pocket expenses for services covered under Parts A and B. Once you reach this limit, you won’t pay for additional covered services, which provides significant financial protection compared to Original Medicare.

Medicare Part C covers a broad range of health care services, but there are specific exceptions. While it includes most benefits of Original Medicare, certain areas, such as hospice care and specific costs related to clinical trials, are not covered.

• Hospice Care: Continues to be covered under Original Medicare, even if you're enrolled in a Medicare Advantage Plan

• Services Outside of Plan Network: Except in emergencies, most plans require you to use network providers

• Some Cosmetic Surgeries: Procedures not deemed medically necessary aren't covered

• Certain Costs of Clinical Trials: While Original Medicare might cover these, Medicare Advantage plans may not

• Costs for Organ Acquisition for Transplants: These plans typically do not cover acquisition costs for organs such as kidneys.

• New Benefits Under Legislation: Temporary benefits due to new laws may not be included

In addition, deductibles, copays and co-insurance amounts can differ significantly from those under Original Medicare

MoneyGeek has compiled a list of frequently asked questions to help you understand the key aspects of Medicare Part C.