When it’s time to choose Medicare coverage, you’re not limited to Original Medicare. Medicare Part C plans, commonly called Medicare Advantage plans, are an option. These plans offer an alternative to Original Medicare coverage, typically with additional benefits.
People consider Medicare Advantage benefits for various reasons. For some, it’s the convenience of having all their coverage bundled under one plan. Others are drawn to added perks, like dental, vision, and hearing coverage and wellness programs.
Cost is another factor. Most Medicare Advantage plans include a limit on yearly out-of-pocket healthcare costs. Many of these plans have low or no monthly premiums, although you still pay your Original Medicare premiums.
Below, we’ll cover what you need to know about Medicare Part C coverage and how to determine if a Medicare Part C plan is right for you.
Medicare Part C (Medicare Advantage) plans bundle your Medicare Part A and B coverage. These plans typically include prescription drug coverage and extra benefits like dental, vision, and hearing.
A Medicare Advantage plan may be a good choice if you want combined coverage, a yearly out-of-pocket limit, and are looking for benefits beyond what Original Medicare provides.
When choosing a Medicare Part C plan, consider your healthcare needs, provider preferences, budget, and the plan’s star rating.
Medicare Part C, or Medicare Advantage, is a type of plan that bundles your Medicare Part A (hospital insurance) and Part B (medical insurance) benefits. Many Part C plans also include Part D (prescription drug) coverage and extra benefits.
One key difference between Medicare Part C and Original Medicare is who provides the coverage. Original Medicare is provided by the federal government. With it, you can see any provider nationwide who accepts Medicare. With Medicare Advantage plans, a private insurance company handles your coverage and manages your care. These plans also have their own network of healthcare providers and hospitals.
To enroll in a Medicare Advantage plan, you must already have both Medicare Part A and Part B, and you must live in the plan’s service area. You also must have an applicable Medicare Advantage enrollment period. Most people with Medicare are eligible for Medicare Part C regardless of their health status, though there are some exceptions.
Medicare Part C might be a good fit if you want dental, vision, and hearing coverage. Some people also choose to enroll in Medicare Part C plans for extra benefits, like the Part B giveback benefit, which reduces your monthly premiums, OTC cards, which work similarly to FSA cards, and free gym memberships. Medicare Part C plans also offer the convenience of having all your Medicare benefits bundled into one plan.
The best Medicare Advantage plan isn’t the same for everyone. Let’s take a closer look at the benefits of Medicare Part C.
Medicare Part C plans offer coverage that may be appealing to many people.:
Most Medicare Part C plans offer coverage and benefits that Original Medicare doesn’t. These include vision coverage for routine eye exams, often with allowances for glasses and contact lenses. Most Part C plans also offer dental coverage for preventative cleanings and exams, with some plans covering more extensive dental work. Hearing tests and an allowance toward hearing aids may also be covered. For many people, these extra benefits can provide significant savings.
Most Medicare Advantage plans include Part D (prescription drug) coverage, so you don’t need a separate drug plan. This can simplify things and help manage medication costs without adding an extra plan.
Some Part C plans include extras, such as:
Memberships to programs like SilverSneakers, with access to gyms and fitness classes
Support for transportation to medical appointments
Home safety modifications, like bathroom grab bars
These are benefits you wouldn’t get with Original Medicare.
Another financial benefit of Medicare Advantage plans is the annual out-of-pocket maximum. This maximum puts a limit on what you’ll pay for covered services in a year and can be a big money saver. In 2025, the Medicare Part C maximum out-of-pocket is $9,350. However, many Medicare Advantage plans set lower limits.
Monthly premiums for Medicare Advantage plans can also be lower than the combined cost of Original Medicare plus a Medigap plan and a separate Part D plan—a common coverage combination. For example, many Medicare Part C plans charge no premium. But you must continue paying your regular Part B premium, which is $185 per month in 2025. You’ll also owe your Part A premium if you have one (note: most people have a $0 premium for Part A).
With Medicare Advantage, you get your Medicare benefits from one plan. Instead of managing separate parts and plans for hospital, medical, and prescription drug coverage, everything is typically bundled together.
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If you’re weighing your options, it helps to understand how Medicare Advantage compares to other Medicare options.
Original Medicare gives you the freedom to see almost any healthcare provider in the country without referrals. This nationwide access is helpful if you travel frequently, split time between homes in different states, or want to see specialists without having to go through a primary care physician.
Medicare Part C plans, on the other hand, have local provider networks. For example, health maintenance organization (HMO) plans typically require referrals to see specialists. Preferred provider organization (PPO) plans offer some out-of-network coverage, though usually at a higher cost. This network structure can limit your options and even delay your care while you find a new doctor.
Cost-wise, as noted above, Medicare Advantage plans include an annual out-of-pocket maximum that caps your yearly spending on covered services. Original Medicare (without Medigap coverage) has no such cap, which means your 20% coinsurance continues no matter how many services you need. To help offset Original Medicare’s unlimited out-of-pocket cost exposure, many people buy Medigap policies to supplement their Original Medicare insurance or switch to a Medicare Part C plan.
Medigap (Medicare Supplement) is an add-on to Original Medicare. This type of plan typically covers most or all of your Original Medicare out-of-pocket costs, like deductibles and coinsurance.
Medigap plans also offer the flexibility to see any Medicare provider without a network, referrals, or prior authorizations. But Medigap plans usually have higher monthly premiums than Medicare Advantage plans and don’t include prescription drug coverage, so you’d need to buy a separate Part D plan.
The enrollment rules also differ between Medicare Part C and Medigap. You can join a Medicare Part C plan only at certain times. These include your Initial Enrollment Period and the Annual Enrollment Period.
With Medigap, your best opportunity to enroll is during the first six months you have Medicare Part B coverage. After this initial election period, insurers can deny coverage or charge more based on your health status—unless you qualify for a Special Enrollment Period.
Medicare Advantage might be a good fit for you if:
You want coverage for dental, vision, hearing, and wellness programs.
You want prescription drug coverage bundled into your plan.
You like the idea of an annual limit on healthcare spending.
You want low or zero-dollar monthly premiums.
You don’t mind choosing healthcare providers from a plan’s local network or getting referrals when needed.
These plans may work well for some, but Medicare Advantage isn’t a good choice for everyone.
You might want to stick with Original Medicare (possibly with a Medigap plan) if:
You travel often or live in different states during the year.
You want to avoid dealing with provider networks, referrals, and prior authorizations.
You have established relationships with healthcare providers who don’t participate in Medicare Advantage networks.
Keep the following in mind when choosing a Medicare Part C plan:
Review your healthcare needs: Write down your medications, doctors, and services you receive regularly. Look for plans that provide good coverage for your needs, plus any extra benefits that matter to you. For example, check that your medications are included in the plan’s formulary (list of covered prescription medications). Otherwise, you could be stuck paying for them out of pocket.
Compare plans: Use Medicare.gov’s Plan Finder tool to compare plans available in your zip code. This tool lets you compare plans side by side based on coverage, costs, and which providers and pharmacies are in-network.
Verify the provider network: Check the plan directory to see if your preferred healthcare providers are in-network. When in doubt, call your providers directly, as directories can sometimes be outdated. You can also call a Chapter Medicare Advisor to ensure the plans you’re looking at have your doctors in network. Think about how comfortable you are with getting referrals (if needed) or paying extra for out-of-network care.
Check the plan’s quality score: While comparing options via the Plan Finder tool, note each plan’s star rating. This ranges from 1 to 5, with 5 being the best. These ratings look at how well the plan performs in different categories like customer service, chronic condition management, and member satisfaction. A higher-rated plan may offer better service overall.
Add up the plan costs: Factor in premiums and what you pay when you receive care, such as the plan’s deductible, copays, coinsurance amounts, and medication costs. Consider how often you seek care, then estimate what your out-of-pocket costs might be.
Once you’ve narrowed down your choice, mark your calendar so you don’t miss your enrollment window. You can sign up for a Medicare Part C by calling a licensed Chapter Medicare Advisor at (855) 900-2427.
Medicare Part C (Medicare Advantage) can be a convenient way to get extra benefits from your Medicare coverage. These plans combine Medicare Part A and Part B, and often prescription drug coverage. Most Medicare Part C plans also offer dental, vision, and hearing coverage, which is not included in Original Medicare.
When deciding on a Medicare Part C plan, consider your coverage needs. Then, compare plans side by side to find the best fit. Keep in mind that a Medicare Advantage plan is not a good choice for everyone. Learn the key details about different Medicare coverage types in this Understanding Medicare 101 guide.
Want a little help sorting through your options? A licensed Medicare advisor from Chapter can help answer your questions, walk you through your choices, and help you compare Medicare Part C plans. Schedule a free appointment with a Chapter Advisor or call us at (855) 900-2427.
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No, there’s no penalty for not having Medicare Part C. Medicare Part C is optional, and you can choose to stay with Original Medicare instead. The Medicare parts that might trigger penalties if you delay enrollment are Part A, Part B, and Part D.
It depends on the plan you choose. Many Medicare Part C plans have no monthly charge. Others have an additional premium, which is often a relatively low amount. You’ll owe some costs out of pocket when you receive care—these will include your deductible, copays, and coinsurance.
It depends on your needs. Medicare Advantage can be worth it if you don’t go to the doctor often, want extra benefits, and don’t mind using network providers. Just keep in mind that, while you can switch back to Original Medicare, you may not be able to enroll in a Medicare Supplement plan outside of your initial election period.
Just like any health plan, many people think Medicare Advantage plans are a bad option. Some people feel limited by provider networks and don’t like needing referrals to see specialists. Others report frustration with prior authorization requirements that limit access to necessary care. Some find that the extra benefits aren’t always as helpful as they expected. That’s why it’s important to ask questions and compare your options before choosing a plan.
Sources
Medicare Hospice benefits. (n.d.). https://www.medicare.gov/publications/02154-medicare-hospice-benefits.pdf
Coleman, K.A. (2024). Final Contract Year (CY) 2025 Standards for Part C Benefits, Bid Review and Evaluation. Center for Medicare & Medicaid Services. https://mabenefitsmailbox.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Final+CY+2025+Standards+for+Part+C+Benefits.pdf
Freed, M., Biniek, J. F., Damico, A., Newman, T. (2024). Medicare Advantage in 2024: Premiums, out-of-pocket limits, supplemental benefits, and prior authorization. KFF. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2024-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization/