top of page
Part C
Understanding
Medicare Advantage
Part C, also called Medicare Advantage, is an all-in-one alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare and often include extra benefits like prescription drug coverage, dental, vision, or hearing.
When It Applies
You have Part A and Part B, live in the plan’s service area, and choose to get your Medicare through a Medicare-approved private plan (you still have Medicare).
What's Covered
All Part A & Part B benefits; most plans include Part D. Hospice and some clinical trial costs are still paid by Original Medicare. Plans may include extra benefits like dental, vision, hearing, fitness, OTC, and transportation.
How Long You're
Covered
Coverage continues while you remain enrolled, pay required premiums, and follow plan rules. Plans may require prior authorization and/or referrals for some services, and benefits/costs can change each year
What You'll Pay
You must keep paying Part B. Your plan may have an additional premium; copays/coinsurance/deductibles vary by plan. Every MA plan includes a yearly out-of-pocket maximum for Part A & B services.
Medicare Advantage Plan Basics
What's Covered
Medically necessary services at in-network providers. Emergency/urgent care is covered anywhere; if a needed service isn’t available in-network, the plan may arrange out-of-network care at in-network cost-sharing.
How Long You're
Covered
Year-round while you’re enrolled and follow plan rules. Networks can change; plans must maintain access and provide transition-of-care help if your provider leaves.
What You'll Pay
In-network copays/coinsurance set by your plan. Out-of-network usually costs more (if allowed). Services without required referrals or prior authorization may not be covered.
Doctors, Hospitals & Approvals (Networks)
When It Applies
Most Medicare Advantage (MA) plans include Part D drug coverage. If your MA plan includes drug coverage, you use that plan for prescriptions. If your MA plan doesn’t include drug coverage (like MSA or some PFFS), you may be able to join a separate Part D plan; joining a separate drug plan with an HMO/PPO MA plan generally disenrolls you from the MA plan.
What's Covered
Drugs on the plan’s formulary (by tier) at network pharmacies or mail order. Coverage rules may apply (prior authorization, step therapy, quantity limits). ACIP-recommended vaccines are $0; each covered Part D insulin is capped at $35/month.
How Long You're
Covered
While you remain enrolled and follow plan rules. Standard 2025 Part D phases apply: deductible (plans may set up to $590), then cost-sharing until your personal Part D out-of-pocket reaches $2,000; after that you pay $0 for covered Part D drugs for the rest of the year.
What You'll Pay
Your plan’s premium (if any), any Part D deductible up to $590, and tiered copays/coinsurance until your OOP hits $2,000—then $0 for covered Part D drugs through December 31. If you delay Part D without creditable coverage, a late-enrollment penalty may apply
Prescription Drugs
When It Applies
You can enroll if you have Part A and Part B and live in the plan’s service area (U.S. citizen or lawfully present). You may join when first eligible (ICEP), during Oct 15–Dec 7 (AEP), Jan 1–Mar 31 (MA-OEP), or during a Special Enrollment Period if you qualify.
What's Covered
All Part A & Part B benefits are provided by the plan. Most plans include Part D and may offer extra benefits (dental, vision, hearing, fitness, OTC, transportation). Hospice remains covered by Original Medicare.
How Long You're
Covered
While you stay enrolled, pay required premiums, and follow plan rules. Plans can change benefits/costs/networks each year (you’ll be notified). MA-OEP changes start the 1st of the next month; AEP changes start Jan 1.
What You'll Pay
You must keep paying Part B and any plan premium, plus plan copays/coinsurance/deductibles. Every MA plan includes a yearly out-of-pocket maximum for Part A & B services. Medigap can’t be used with MA; getting it back later is limited to certain guaranteed-issue rights.
Enrollment & Changing Plans
Quick Basics about Part C
-
Combines Part A and Part B coverage in one plan; most include Part D (drug coverage) too.
-
May offer extra benefits such as dental, vision, hearing, fitness programs, and over-the-counter allowances.
-
Plans use provider networks (like HMOs or PPOs) and rules can vary by county.
-
You must keep paying your Part B premium in addition to any Advantage plan premium.
*DISLCAIMER: Plans must follow Medicare rules. Coverage, costs, networks, and extra benefits vary by plan and may change each year. You must continue to pay your Part B premium. Check your plan’s Evidence of Coverage (EOC) for details.”
bottom of page