Table of ContentsView AllTable of ContentsWho Is EligiblePremiumsCoverageMedigapFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Who Is Eligible
Premiums
Coverage
Medigap
Frequently Asked Questions
Medicare has four categories of coverage:
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The popularity of Medicare Part C plans has been steadily increasing. As of 2023, 51% of all Medicare beneficiaries had coverage under Part C.
This article will explain how Medicare Part C works, including eligibility, costs, and benefits. Throughout the article, we’ll use the terms Medicare Part C and Medicare Advantage interchangeably, as they both mean the same thing.
Who Is Eligible for Medicare Part C?
To enroll in a Medicare Part C (Medicare Advantage) plan, you must be enrolled in Medicare Part A and Part B (or enrolling in them if you’ve just become eligible), and you must live in the service area of the Part C plan.
Before 2021, Medicare Part C was generally unavailable to Medicare beneficiaries who had end-stage renal disease (kidney failure). But that changed as of 2021 due to the 21st Century Cures Act.As a result of that legislation, Medicare beneficiaries are eligible for any Medicare Advantage plan available in their area, regardless of whether they have end-stage renal disease.
Most areas of the country have Medicare Part C plans available. But there are 68 rural counties, mostly in the Western U.S., where there are no Part C plans available as of 2024.
If you’re in one of those counties, your only option isOriginal Medicare, which means you’ll get Medicare Part A and Part B directly from the federal government. (You’ll still likely need to purchase private coverage as well, as you’ll need Medigap and Part D unless you have supplemental coverage from an employer or Medicaid.)
Assuming Medicare Advantage plans are available in your area, you can enroll in Medicare Part C when you’re first eligible for Medicare during your initial enrollment period.
Or, you can switch to a Medicare Part C plan during the annual open enrollment period in the fall, which runs from October 15 to December 7. In that case, the Part C coverage will take effect on January 1. That window can also be used to switch from one Part C plan to another.
Paying a Premium for Medicare Part C
A premium is an amount you pay each month to purchase your coverage (you pay it regardless of whether you need medical care). Some Medicare Part C plans have premiums, while others do not.
People with Medicare Part C still have to pay the monthly premium for Medicare Part B since the Part C plan provides the benefits of Medicare Part A and Part B combined into one private plan.
For most Medicare beneficiaries, Medicare Part A does not have monthly premiums. But for those who don’t have enough work history (or spouse’s work history) to qualify for premium-free Medicare Part A, there will be a premium for Part A as well as Part B.
In 2024, the Part B premium for most Medicare beneficiaries is $174.70/month (it’s higher for people with income above $103,000).So most people with Medicare Part C have to pay at least that amount for their coverage.
As of 2024, 89% of Medicare Advantage plans for individual enrollment include prescription drug coverage, and 66% have no additional premium other than the premium for Part B.
Some of these plans even have a “giveback” rebate that pays a portion of the Part B premium on the enrollee’s behalf.So in some areas, it’s possible to have Medicare coverage under a Part C plan and pay less than the standard Part B premium each month.
The other 34% of Part C plans have a premium that has to be paid in addition to the Part B premium. These premiums vary from one plan to another.
Across all Medicare Part C plans, including those that have no premium, the average premium in 2024 is $18.50/month. Again, that’s in addition to the $174.70/month that most Medicare beneficiaries pay for Medicare Part B.
Medicare Part C Coverage
Some Medicare Advantage plans are Special Needs Plans (SNPs) designed to cater to enrollees with specific health needs. But most Medicare Advantage plans are open to all beneficiaries, and it’s important to carefully compare the various options before selecting a plan.
As noted above, as of 2024, 89% of Medicare Advantage plans have integrated Part D coverage (these plans are called MA-PDs).
But the specifics of the coverage for Part A and Part B benefits will vary considerably from one Part C plan to another. And out-of-pocket costs (deductibles,copays, coinsurance) will not be the same as they are under Original Medicare.
Unlike Original Medicare (Part A and Part B), Medicare Part C plans do have a cap on how high a person’s out-of-pocket costs can be, as long as theystay in-network(only receive care from approved healthcare providers) and follow plan rules for things likeprior authorization(receive approval before getting a healthcare service).
The government-set cap is $8,850 in 2024, although many Part C plans have a maximum out-of-pocket cap that’s lower than this.
Note that this limit does not apply to prescription costs if the Part C plan is an MA-PD. The vast majority of Part C plans do include Part D benefits, but Part D does not have a cap on out-of-pocket costs, regardless of whether it’s purchased as a stand-alone plan or part of a Medicare Advantage plan.
Also, Medicare Part C plans have healthcare provider networks that vary in scope; some are quite localized. Some plans will require a referral from a primary care provider to see a specialist—this is generally the case with Medicare Advantage health maintenance organizations (HMOs).
These factors will need to be considered in addition to the basic considerations like deductible (the amount you pay out-of-pocket before benefits begin) and copay (a set amount paid per service) amounts.
Medicare Part C Pros and Cons
Medicare Part C pros:
Medicare Part C cons:
Should I Enroll in Medigap?
If you are enrolled in Medicare Part C, you do not need aMedigap plan(Medicare Supplement).
If you have Original Medicare plus a Medigap plan and want to switch to Medicare Advantage, you’re allowed to keep the Medigap plan. But you will not be able to use it while you have Medicare Advantage, and you would have to continue paying monthly premiums to maintain the Medigap plan.
Keeping it would only be useful if you were to decide later that you wanted to return to Original Medicare and had health conditions that would make you ineligible to re-enroll in a Medigap plan.
Note that you have a one-year trial right period in such situations. You can drop your Medicare Advantage plan, return to Original Medicare, and re-enroll in the Medigap plan withoutmedical underwriting(an approval process that considers pre-existing conditions). It’s unnecessary to keep your Medigap plan just in case while you test out a Medicare Advantage plan for less than a year.
You’ll want to keep the long-term picture in mind when enrolling in Medicare. Although there’s an annual open enrollment period each fall when you can switch your Medicare Part C and D coverage, there is no similar ongoing enrollment opportunity for Medigap plans.
In most states, you only have one six-month window (when you’re 65 and enrolled in Medicare Part A and B), during which you can enroll in Medigap without medical underwriting.
If you enroll in Medicare Advantage and then decide several years later that you want the more robust coverage and provider access that goes along with Original Medicare + Medigap, you might find that medical underwriting makes it difficult or impossible to make this switch.
These are important factors to keep in mind when you’re enrolling in Medicare; you want something that fits your budget and lifestyle but will also keep up with your needs in later years.
How to Enroll in Medicare Part CDuring your initial enrollment period or the annual open enrollment period, you can enroll in a Medicare Part C plan through Medicare’s plan finder website, through the insurance company’s website, or with the help of a broker. Medicare.gov has more information aboutenrolling in a Part C plan.
How to Enroll in Medicare Part C
During your initial enrollment period or the annual open enrollment period, you can enroll in a Medicare Part C plan through Medicare’s plan finder website, through the insurance company’s website, or with the help of a broker. Medicare.gov has more information aboutenrolling in a Part C plan.
Summary
Medicare Part C has been gaining popularity, and about 51% of all Medicare beneficiaries are enrolled in Part C rather than Original Medicare.
Medicare Part C plans must follow certain federal guidelines in terms of services that must be covered and out-of-pocket limits. But the insurers that offer Part C plans have a lot of flexibility to design their benefits and provider networks.
The coverage details will vary considerably from one Part C plan to another (unlike Original Medicare, which has uniform coverage throughout the United States).
A Word From Verywell
If you’re transitioning to Medicare, it’s important to consider all of your coverage options before deciding which one will best fit your needs.
You’ll likely find that Medicare Advantage plans have lower monthly premiums than Original Medicare plus Medigap plus a stand-alone Part D plan. They will also tend to offer additional supplemental benefits that you can’t get with Original Medicare + Medigap. But Advantage plans will also tend to have higher out-of-pocket costs and a more limited healthcare provider network.
There are a lot of factors to keep in mind when you’re selecting your Medicare coverage. A Part C plan might fit your needs quite well, and you’ll have a chance to pick a different plan each year during the annual open enrollment periods.
But note that if you have had a Medicare Advantage plan for more than a year and also have pre-existing medical conditions, you may find it difficult or impossible to transition to Original Medicare + a Medigap plan due to Medigap underwriting rules in most states.
Learn MoreOriginal Medicare versus Medicare Advantage
No, Medicare Part C (Medicare Advantage) and Medigap are not the same thing. Medicare Part C replaces Medicare Part A and Part B with a single private plan that will likely also include Part D coverage and various extra benefits. Medigap is a private plan that supplements Medicare Part A and Part B but does not replace them.Learn MoreHow Medigap Policies Work
No, Medicare Part C (Medicare Advantage) and Medigap are not the same thing. Medicare Part C replaces Medicare Part A and Part B with a single private plan that will likely also include Part D coverage and various extra benefits. Medigap is a private plan that supplements Medicare Part A and Part B but does not replace them.
Learn MoreHow Medigap Policies Work
Medicare Part C is Medicare Advantage. These are private plans that are designed to replace Medicare Part A and Part B and offer all of a person’s Medicare coverage through one plan.Medicare Part D is prescription drug coverage. These are also private plans. They can be purchased on a stand-alone basis to supplement Medicare Part A and Part B, or they can be obtained as part of a Medicare Advantage plan, since most Advantage plans have integrated Part D coverage.Learn MoreWhat You Need to Know About Medicare Part D
Medicare Part C is Medicare Advantage. These are private plans that are designed to replace Medicare Part A and Part B and offer all of a person’s Medicare coverage through one plan.Medicare Part D is prescription drug coverage. These are also private plans. They can be purchased on a stand-alone basis to supplement Medicare Part A and Part B, or they can be obtained as part of a Medicare Advantage plan, since most Advantage plans have integrated Part D coverage.
Medicare Part C is Medicare Advantage. These are private plans that are designed to replace Medicare Part A and Part B and offer all of a person’s Medicare coverage through one plan.
Medicare Part D is prescription drug coverage. These are also private plans. They can be purchased on a stand-alone basis to supplement Medicare Part A and Part B, or they can be obtained as part of a Medicare Advantage plan, since most Advantage plans have integrated Part D coverage.
Learn MoreWhat You Need to Know About Medicare Part D
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Medicare and Medicaid Services.Medicare monthly enrollment.Centers for Medicare and Medicaid Services.How Original Medicare works.Kaiser Family Foundation.Medicare Advantage 2024 spotlight: first look.KFF.Medicare Advantage in 2023: enrollment update and key trends.Centers for Medicare and Medicaid Services.Who can join a Medicare Advantage plan?Library of Congress.H.R.34 - 21st Century Cures Act.Centers for Medicare and Medicaid Services.Costs.Medicareresources.org.How the Medicare Part B premium reduction might save you money.Medicareresources.org.How are Medicare benefits changing for 2024?.Centers for Medicare and Medicaid Services.Get ready to buy: your Medigap open enrollment period.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Medicare and Medicaid Services.Medicare monthly enrollment.Centers for Medicare and Medicaid Services.How Original Medicare works.Kaiser Family Foundation.Medicare Advantage 2024 spotlight: first look.KFF.Medicare Advantage in 2023: enrollment update and key trends.Centers for Medicare and Medicaid Services.Who can join a Medicare Advantage plan?Library of Congress.H.R.34 - 21st Century Cures Act.Centers for Medicare and Medicaid Services.Costs.Medicareresources.org.How the Medicare Part B premium reduction might save you money.Medicareresources.org.How are Medicare benefits changing for 2024?.Centers for Medicare and Medicaid Services.Get ready to buy: your Medigap open enrollment period.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Medicare and Medicaid Services.Medicare monthly enrollment.Centers for Medicare and Medicaid Services.How Original Medicare works.Kaiser Family Foundation.Medicare Advantage 2024 spotlight: first look.KFF.Medicare Advantage in 2023: enrollment update and key trends.Centers for Medicare and Medicaid Services.Who can join a Medicare Advantage plan?Library of Congress.H.R.34 - 21st Century Cures Act.Centers for Medicare and Medicaid Services.Costs.Medicareresources.org.How the Medicare Part B premium reduction might save you money.Medicareresources.org.How are Medicare benefits changing for 2024?.Centers for Medicare and Medicaid Services.Get ready to buy: your Medigap open enrollment period.
Centers for Medicare and Medicaid Services.Medicare monthly enrollment.
Centers for Medicare and Medicaid Services.How Original Medicare works.
Kaiser Family Foundation.Medicare Advantage 2024 spotlight: first look.
KFF.Medicare Advantage in 2023: enrollment update and key trends.
Centers for Medicare and Medicaid Services.Who can join a Medicare Advantage plan?
Library of Congress.H.R.34 - 21st Century Cures Act.
Centers for Medicare and Medicaid Services.Costs.
Medicareresources.org.How the Medicare Part B premium reduction might save you money.
Medicareresources.org.How are Medicare benefits changing for 2024?.
Centers for Medicare and Medicaid Services.Get ready to buy: your Medigap open enrollment period.
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