Part C
Medicare Advantage Plans: How Part C Works
A private plan that takes over how you receive Parts A and B, usually with drug coverage included and a cap on what you can spend in a year.
What it actually is
Medicare Advantage, sometimes called Part C, is a plan from a private insurance company that replaces the way you receive your Original Medicare benefits. The plan must cover everything Parts A and B cover, and most also include Part D prescription coverage in the same plan.
The two things that define an Advantage plan are the network and the out-of-pocket maximum. The network decides which doctors and hospitals you can use. The out-of-pocket maximum is a yearly cap on what you can be asked to pay for covered care, which Original Medicare on its own does not have.
Who it tends to suit
- People comfortable using a defined network of doctors and hospitals
- People who want a lower monthly cost and can handle copays when they use care
- People who want prescription coverage and extras bundled into one plan and one card
- People who mostly get care close to home
Who it tends not to suit
- People who travel a lot or spend part of the year in another state
- People seeing specialists across several unconnected hospital systems
- People who would rather pay a predictable monthly amount than variable costs when care happens
The part almost nobody explains
Advantage plans are approved county by county. The plan a friend recommends may not be sold where you live, and two people an hour apart can be offered completely different plans. That is why a useful conversation starts with your ZIP code rather than a brochure.
Networks also change. A hospital system in the network this year may not be next year, which is one of the reasons a yearly check is worth doing even when nothing about your health has changed.
What to check before choosing one
- Your doctors. Checked against the carrier's own current directory, not assumed.
- Your prescriptions. By name and dose, against that plan's drug list.
- Your hospital. The one you would actually want to be taken to.
- The out-of-pocket maximum. This is the number that matters in a bad year.
- Out-of-network rules. HMO and PPO behave very differently when you go outside the network.
Questions
Commonly asked
Do I keep my Medicare card?
Yes, you keep your red, white and blue Medicare card, but you use the plan's card for care. You also continue paying your Part B premium.
Can I see any doctor?
Within the plan's network, yes. Outside it depends on the plan type. An HMO generally covers out-of-network care only in an emergency, while a PPO usually covers it at a higher cost to you.
Is prescription coverage included?
Usually, but not always. Some Advantage plans have no drug coverage, and joining a separate Part D plan alongside certain Advantage plans can actually remove you from the Advantage plan. Worth checking before assuming.
Which one is right depends entirely on you
There is no plan type that suits everybody. It comes down to which doctors you want to keep, which prescriptions you take, whether you travel, and what you could absorb if something went wrong. That is a ten minute conversation, not a web page.
Medicare Supplement (Medigap) Plans Explained
You keep Original Medicare and add a policy that covers what Medicare leaves to you. Any doctor who accepts Medicare works, with no network to check.
Part D Prescription Drug Coverage Explained
Every plan covers a different list of drugs at different tiers. That is why there is no plan that is cheapest for everyone, and why your own list has to be checked by name.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.