What does Medicare Part C Cover?

Medicare Part C plans are private Medicare plans which pay instead of Medicare. This plan resembles group insurance benefits, similar to what you may have had through former employers. Generally, there is a local network of providers that you will use. You pay copays for many routine services like visits to the doctor, lab work, ambulance, surgeries, hospital stays, urgent care, and more.

Medicare Part C covers the same services as Part A and B (both hospital and outpatient benefits). However, instead of paying deductibles and 20% of your medical services, you pay the plan’s copays.

Medicare Part C is better known as Medicare Advantage. This plan acts as a package where you will have Part A, Part B, and usually Part D together in one plan. You will have one ID card that you use at the hospital, doctor’s office, and pharmacy. Most Advantage plans include a built-in Part D drug plan, although in some areas you can find them without Part D.

How do I Enroll in Medicare Part C?

Medicare Part C, a plan we know as Medicare Advantage, is not a program that you enroll in at Social Security. Medicare Part C plans provide you an alternative to traditional Medicare. They are optional, so not everyone needs Part C.

You can enroll in a Medicare Advantage plan when you first get Medicare Part B. You can also do so during the annual election period each fall, which is from October 15 to December 7. Your benefits will then begin on January 1.

Who is Eligible for Medicare Part C?

To be eligible for Medicare Part C, or Medicare Advantage, you must first be enrolled in Medicare Part A and B and live in the service’s area. You can enroll if you wish to get your benefits through a private insurance company instead of Original Medicare.

Any Medicare beneficiary, regardless of age, can purchase a plan if they meet these criteria:

  • You are enrolled in both Medicare Part A and B. Many people make the mistake of trying to drop Part B once they enroll in Medicare Part C. If you drop Part B, you will immediately be kicked out of your Part C plan.
  • You live in the plan’s service area. This Medicare Part C eligibility will be based on the address that you have on file with Social Security. You must choose a plan that operates in that same county. Some plans will be specific to only one or two counties, while others might span the whole state.
  • You don’t have End-Stage Renal Disease (ESRD). This is the only medical question on a Part C application.

Remember, Medicare Advantage plans have election periods, so you can only enroll during your Initial Enrollment Period or the Annual Election Period in the fall. There are also Special Election Periods (SEPs) for certain circumstances, such as if you move out of state and lose your plan.

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