Medicare Part C

Medicare Part C, or Medicare Advantage, is coverage from a private insurance company. These plans can offer an array of benefits ranging from dental, vision, hearing, and gym memberships. Many Part C plans have a $0 premium, so it’s easy to see what attracts people to these plans. But, even with all the perks, there are downfalls to Medicare Advantage.

What is Medicare Part C?

When you choose a Medicare Advantage plan, a private company will handle your benefits and claims instead of the federal government. The policy must cover at least as much as Medicare. Unless you go out of the network.

Those with a Health Maintenance Organization policy will pay 100% out of pocket when they leave the network. But, if you have a Preferred Provider Organization plan, there will be some coverage. In some cases, you pay 40% of the cost out of the network.

Also, there are Health Maintenance Organization Point of Service policies that allow you to see some doctors out of network at a higher rate. The Private Fee for Service policies require you to call the doctor before services are rendered to ensure coverage is still available, you must do this EVERY time before an appointment. For those that have low-income or chronic issues, Medicare Advantage Special Needs plans can help. But, you must live in the service area of the plan to qualify.

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What Does Medicare Part C Cover?

Part C must cover all services that have coverage under Part A and Part B. Most plans include more than Medicare.

Also, many Part C plans cover preventive care and prescription drugs; some offer dental and vision benefits. Some plans even include over the counter medication benefits.

If you’re in a Private-Fee for Service (PFFS) plan without drug coverage, you can add drug coverage by enrolling in a Part D plan. No matter which policy you choose, it’s important to verify the Part D formulary.

Over 90% of Advantage plans include transportation assistance, and over 95% cover a meal benefit. Also, some plans include telehealth services or in-home support. Further, some Medicare Advantage plans offer Part B give-back option that lowers or eliminates your Part B premium costs.

Some Medicare Advantage plans now cover Long Term Care benefits. These benefits aren’t mandatory, so not all plans offer them. But, there may be plans in your area that include these benefits.

But, just because everyone else is doing it, doesn’t mean it’s best for you. There is a reason people talk about why Medicare Advantage plans are bad. Before you choose your policy, compare Medigap and Advantage, so you know you’re getting the best value for you.

Eligibility for Part C

You must have Both Part A and Part B to be eligible for Part C. The one health question that can disqualify you for a Medicare Advantage plan is, “do you have End-Stage Renal Disease?” Unless you develop End-Stage Renal Disease when you’re already on a Medicare Advantage plan, you won’t be able to select this coverage.

If you already have Medicare Advantage when you develop ESRD, you might be able to select a different plan with the same company. Also, if the plan leaves the area, you’ll have a one-time right to choose another policy.

Further, if an ESRD Special Needs Plan is available in your area, you may join. Also, if you have a successful kidney transplant and no longer have ESRD, you’ll qualify for Medicare Advantage coverage.

CMSnewsroom claims ESRD patients will have access to Medicare Advantage plans by 2021 or 2022.

Medicare Part C vs Original Medicare

Medicare Advantage Plans

Under Part A and B, there are no provider networks; so, you can go to any doctor or hospital you want, so long as they accept Medicare.

Private insurance companies offer Part C through HMOs and PPOs. For each, there’s a list of “in-network” healthcare providers.

If you go to a provider out of the network, your claim may not have coverage, or you’ll pay more for services.

By comparing Medicare Advantage vs. Medicare Supplement side by side, you can figure out which you prefer.

How Much Does Part C Cost?

Many Advantage plans have a $0 premium. But, some areas have a higher premium costing plan.

The average Medicare Advantage plan cost is about $23 a month. Of course, your location is the determining factor in the plans available to you.

When you live somewhere that has little to now quality plan options, consider the benefits of Medigap.

What Happens if You’re Disenrolled From Your Medicare Advantage Plan?

You may be unenrolled from a Medicare Advantage plan due to nonpayment of premiums. This will only happen after you receive notice from your plan and the grace period is over.

Single Grace Period – If one or more payments have gone unpaid during your grace period, the plan can discontinue coverage.

Rollover Grace Period – If you owe more than one premium but manage to pay for a minimum of one premium during your grace period, the period will end, and your plan will notify you of a new grace period.

Notifications continue until you catch up on premiums. But, if you fail to make a premium payment during this time, you face dis-enrollment.


How is Advantage Part C funded?
Upon agreeing to pay your claims, the Medicare Advantage plan receives funding from the government. So, instead of Medicare worrying about paying your claim, it’s the responsibility of the Part C insurer. Some plans also request you to make premium payments. Depending on where you live, the cost of an Advantage plan could be higher than in other areas.
Is Medicare Part C the same as a Medicare Supplement plan?
No, Medicare Supplement plans work with Medicare to provide you the most comprehensive policy.
Why do I need Medicare Part C?
You don’t need Medicare Part C, it’s not mandatory. But, some people choose Part C instead of only Medicare or instead of a Medigap policy.

How to Enroll in Medicare Part C

At MedicareFAQ, we help you navigate the world of Medicare. We'll explain the pros and cons of your options and research all the top providers in your area. We can look at your Medicare Advantage checklist to find the policy that is most suitable for you.

An agent can ask you a few questions about your needs and wants in a policy. Then, they can help you identify the plan with the most value for you.

Our agents have helped Medicare recipients just like you! If you're ready to compare rates with the top carriers, give us a call at the number above!

Or, fill out an online rate form to get the process started today.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

13 thoughts on “Medicare Part C

  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.

  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


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