Medicare Part C (Medicare Advantage) Explained

Medicare Advantage Plans, also known as Part C, are an alternative way to get your Medicare coverage. These plans are offered by private insurance companies approved by Medicare and must follow Medicare rules.

When you enroll in a Medicare Advantage Plan, the plan provides all of your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. All plans cover emergency and urgent care, and most include prescription drug coverage (Part D).

Medicare Advantage Plans may also offer additional benefits not covered by Original Medicare, such as vision, hearing, dental, fitness, and wellness programs.

Hospice care is still covered by Original Medicare even if you are enrolled in a Medicare Advantage Plan.

Who Can Enroll in a Medicare Advantage Plan?

You can generally enroll in a Medicare Advantage Plan if:

• You have Medicare Part A and Part B
• You live in the plan’s service area
• You are a U.S. citizen or lawfully present in the United States

People with End-Stage Renal Disease (ESRD) are eligible to enroll in Medicare Advantage plans, though plan availability may vary.

How Medicare Advantage Plans Work

Medicare pays a fixed amount each month to the insurance company providing your plan. In return, the plan manages your care and sets rules for:

• Provider networks
• Referrals to specialists
• Copayments and deductibles

Costs and rules vary by plan.

Types of Medicare Advantage Plans

Common types include:

• HMO (Health Maintenance Organization) – Requires use of network providers and referrals for specialists (except emergencies)
• PPO (Preferred Provider Organization) – Allows out-of-network care at a higher cost, usually without referrals
• PFFS (Private Fee-for-Service) – Lets you see any Medicare-approved provider who accepts the plan’s terms
• MSA (Medical Savings Account) – Combines a high-deductible plan with a medical savings account
• SNP (Special Needs Plan) – Designed for people with specific health conditions or circumstances



How Much Do Medicare Advantage Plans Cost?

Costs vary by plan and may include:

• Your Part B premium
• A monthly plan premium (some plans have $0 premiums)
• Deductibles, copayments, or coinsurance
• A yearly out-of-pocket maximum for covered medical services

Some plans may help pay all or part of your Part B premium.

If you have limited income and resources, you may qualify for:

• Extra Help with prescription drug costs
• State assistance with Medicare premiums
• 
  

When Can You Enroll or Make Changes?

You can join, switch, or drop a Medicare Advantage Plan during:

• Initial Enrollment Period (around your 65th birthday)
• Annual Election Period (Oct 15 – Dec 7)
  Coverage begins January 1
• Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31)
  Switch MA plans or return to Original Medicare
• Special Enrollment Periods (SEPs) for certain life events, such as:
• Moving
• Losing employer coverage
• Qualifying for Medicaid or Extra Help
• Living in an institution
• 
  

For a full list of SEPs, visit Medicare.gov.