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Part C
Understanding
Medicare Advantage
Medicare Advantage, also called Part C, is another way to receive your Medicare Part A and Part B benefits. Medicare Advantage plans are offered by Medicare-approved private insurance companies. Coverage, costs, networks, and plan requirements vary by plan and service area.
When It Applies
You have Medicare Part A and Part B, live in the plan’s service area, and choose to receive your Medicare benefits through a Medicare-approved private plan.
What's Covered
Medicare Advantage plans must cover the medically necessary services covered by Original Medicare. Coverage details and plan requirements vary.
How Long You're
Covered
Coverage continues while you remain enrolled and meet the plan’s requirements. Network, referral, and prior authorization rules may apply. Plan benefits and costs can change each year.
What You'll Pay
You must continue paying your Part B premium. Medicare Advantage plans may have additional premiums, deductibles, copayments, or coinsurance. Costs vary by plan. Medicare Advantage plans also include an annual out-of-pocket limit for covered Part A and Part B services.
Medicare Advantage Plan Basics
When It Applies
For non-emergency care, provider network requirements vary by Medicare Advantage plan. Referrals or prior authorization may also be required.
What's Covered
Medically necessary covered services are provided according to the plan’s network and coverage rules. Emergency and urgent care may have different requirements.
How Long You're
Covered
Coverage continues while you remain enrolled and meet the plan’s requirements. Provider networks can change, so it’s important to review current plan information.
What You'll Pay
Copayments or coinsurance vary by plan and service. Costs may be different depending on whether a provider is in-network or out-of-network, when out-of-network coverage is available.
Doctors, Hospitals & Approvals (Networks)
When It Applies
Many Medicare Advantage plans include prescription drug coverage. Coverage and requirements vary by plan.
What's Covered
Covered prescription drugs are listed on the plan’s formulary. Pharmacy networks, drug tiers, and coverage requirements may vary by plan.
How Long You're
Covered
Prescription drug coverage continues while you remain enrolled and meet the plan’s requirements. Formularies and coverage rules can change.
What You'll Pay
Prescription drug costs vary by plan, medication, pharmacy, and coverage stage. Deductibles, copayments, or coinsurance may apply. Review your plan’s current Evidence of Coverage and formulary for specific costs.
Prescription Drugs
When It Applies
You may enroll in Medicare Advantage if you have Medicare Part A and Part B, live in the plan’s service area, and meet applicable eligibility requirements. Enrollment is allowed during certain Medicare enrollment periods, including the Initial Enrollment Period, Annual Enrollment Period, Medicare Advantage Open Enrollment Period, and certain Special Enrollment Periods.
What's Covered
Medicare Advantage plans provide coverage for Medicare Part A and Part B services. Coverage details, network requirements, and plan rules vary by plan. Hospice care is generally covered through Original Medicare.
How Long You're
Covered
Coverage continues while you remain enrolled and meet the plan’s requirements. Plan costs, benefits, and provider networks can change each year. Effective dates for plan changes depend on the enrollment period used.
What You'll Pay
You must continue paying your Part B premium. Medicare Advantage plans may have additional premiums, deductibles, copayments, or coinsurance. Costs vary by plan, and plans include an annual out-of-pocket limit for covered Part A and Part B services.
Enrollment & Changing Plans
Quick Basics about Part C
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Medicare Advantage combines your Medicare Part A and Part B coverage through a Medicare-approved private plan.
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Coverage, costs, provider networks, and plan requirements vary by plan and service area.
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Plan benefits and costs may change each year.
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You must continue paying your Medicare Part B premium in addition to any applicable plan premium.
DISCLAIMER: This page provides general educational information about Medicare Advantage (Part C). Coverage, costs, provider networks, and plan requirements vary by plan and service area and may change each year. Review the plan’s Evidence of Coverage for specific details.
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