Medicare Advantage plans, also known as Part C, were introduced to give Americans an alternative to the federal government’s traditional Medicare program. Medicare Advantage is sold by private companies and provides an array of benefits not included in Original Medicare. Read on to learn how Medicare Part C works so you can optimize your medical insurance.

What Does Medicare Part C Cover?

Stethoscope and a medical record with Medicare Part C letteringsPrivate companies approved to deliver Medicare follow guidelines set by the United States Government. All Medicare Advantage Part C plans must cover the same basic benefits as traditional Medicare:

  • Part A covers hospital services related to an inpatient stay, including semi-private rooms and meals.
  • Part B covers essential medical services including doctor visits, lab tests, durable medical equipment and treatments.

Medicare also allows private insurers to offer additional benefits not covered by Original Medicare. Plans may deliver a combination of benefits such as prescription drugs, vision, dental, hearing, gym memberships, and health and wellness programs.

How Does Medicare Part C Work?

When you enroll in a Medicare Advantage plan, you pay monthly Part C premiums to the insurance company and Part B premiums to the government. While Medicare pays most of your medical costs, you’re responsible for deductibles and cost-sharing. Some Medicare Advantage plans have a $0 monthly premium. Unlike Original Medicare, all Part C plans cap the annual out-of-pocket costs you pay.

How Do Medicare Advantage Plans Differ?

Most Medicare Advantage plans limit the health care providers you can see. There are four main types of Part C plans with different features and costs.

  • Health Maintenance Organization (HMO) plans require you to use providers within the HMO network. You must choose a primary care doctor and obtain a referral before seeing a specialist.
  • Preferred Provider Organization (PPO) plans allow you to see any provider. Those within the plan’s network typically cost less. You don’t need a primary care physician or referrals to specialists.
  • Private Fee-for-Service (PFFS) plans allow you to see any Medicare provider that accepts the plan’s payment terms. You don’t need a primary care doctor or referrals to specialists.
  • Special Needs Plans (SNPs) are designed for those with certain chronic illnesses such as chronic heart failure, diabetes and dementia.

Can I Combine Part C Plans With Other Plans?

Medicare Part C plans can’t be combined with other private health insurance such as Medicare Supplement Insurance (Medigap). In most cases, you can’t combine Part C plans with stand-alone Part D prescription drug coverage, with the exception of some PFFS plans. If you want a drug plan, you must choose a Part C policy that offers this benefit.

How Do I Join Medicare Advantage?

When you first enroll in Medicare Parts A and B, your medical insurance is provided by the federal government. Once you have Original Medicare, you may switch to a Medicare Advantage plan in your service area. You can enroll in a Part C plan during your initial enrollment period or the general Medicare enrollment period between October 15 and December 7 each year.