Medicare Part C Explained

What is Medicare Part C?

Medicare Part C is another name for Medicare Advantage plans. With Medicare Part C, you receive your Medicare coverage through a private insurance company. Medicare Advantage plans work differently from Supplement plans. They combine your Part A Hospital, Part B Medical, and sometimes Part D Prescription Drug coverage, into one easy-to-use plan. Medicare Advantage also gives you extra benefits and services that Original Medicare doesn’t cover.

Do I need Medicare Part C?

Enrolling in a Medicare Part C plan offers many benefits that can make it an appealing option for Medicare members. First, Part C provides all-in-one coverage by combining Part A (hospital), Part B (medical), and often Part D (prescription drugs) into a single plan. This simplifies coverage and allows you to manage your care with one plan. Second, Medicare Part C, or Medicare Advantage plans, often include many important benefits not covered by Original Medicare, such as dental, vision, and hearing coverage, wellness programs, and transportation services. Medicare Advantage plans may also help you save money by protecting against unexpected costs because they have a maximum out-of-pocket cost that limits your yearly spending on health care.

The choice to enroll in a Part C plan is up to the individual. A good decision factors in things like preferred providers, health needs, budget, and desired coverage options. For example, enrolling in a Medicare Advantage plan might make sense for someone looking for coverage with added benefits like dental and vision care. It can also be beneficial for someone looking to manage all their Medicare services with one plan rather than having three separate plans for hospital, doctor, and prescription drug coverage. 

What does Medicare Part C cover?

Medicare Part C coverage includes:  

• All services that Medicare Part A and Part B cover, except hospice care (which is covered by Medicare).
• Additional benefits and services that Original Medicare does not cover, that can include:
  • Routine hearing, dental, and vision exams.
  • Hearing aids or glasses (except for glasses following cataract surgery).
  • Emergency medical assistance while traveling outside the U.S.
  • Fitness memberships.
  • An allowance to buy health care products.
  • Prescription drug coverage (with some plans).

How much does Medicare Part C cost?

Because Medicare Advantage (Part C) plans are offered by private insurance companies, costs vary widely by insurer. Medicare Part C costs include:

• Part A and Part B monthly premiums, if applicable.
• Your Medicare Advantage plan (Part C) monthly premium, if applicable.
• Any out-of-pocket costs such as copays, deductibles, and coinsurance (these costs vary according to your chosen plan).

The average premium for Medicare Advantage (Part C) can vary based on the plan you choose, your location, the insurance provider, coverage options, and additional benefits offered. Plan premiums can range from $0 to $200 depending on the level of coverage and benefits offered. 

Medicare Advantage plans can have lower out-of-pocket costs than Original Medicare.

Is Medicare Part C free?

While some Medicare Advantage (Part C) plans offer $0 premiums or low out-of-pocket costs, they are not entirely free. Some plans have deductibles that must be paid before your plan starts to pay for care. Plans typically have copays or coinsurance for covered services like doctor visits, hospital stays, or prescription drugs. Part D drug coverage is often included in your Medicare Advantage (Part C) plan, but you may have to pay out-of-pocket costs for copays for covered drugs. You may also still have to pay your Part A and Part B monthly premiums, but some plans cover a portion of Part B premiums.

Medicare Part C eligibility

To join a Medicare Advantage (Part C) plan, you must:

• Be a U.S. citizen or lawfully present in the United States.
• Be enrolled in Medicare Parts A and B. Learn when to enroll in Medicare Parts A and B.
• Live for six months or more each year in the plan’s service area.

Why choose UPMC for Life?

UPMC for Life is a Medicare Advantage (Part C) plan that’s been around for 22 years. We are more than 200,000 members strong and growing!

We offer affordable medical and prescription benefits in one easy-to-use plan. We’re committed to providing you with the high-quality health care and access to the care you need so you can live your best life.

Here are just a few benefits you get with UPMC for Life:

• PPO plan options that give you affordable coverage with access to out-of-network providers.
• Part D prescription drug coverage with $0 Tier 1 and Tier 2 Rx copays at preferred pharmacies.
• The UPMC for Life Flex Spend Card gives you additional dollars to spend on things that help you stay healthy and independent. Use it when you need to for doctor office copays, fitness, over-the-counter products, and dental, vision, and hearing services.
• Dental allowance for many dental services, including coverage for dentures (on most plans). Plus, oral exams, cleanings, and x-rays.
• A hearing aid exam, a hearing aid fitting, and a great discount on hearing aids.
• A routine vision exam and an allowance for contact lenses and frames, including all lens types, like progressive and transitional.
• FREE unlimited gym memberships, one FREE personal training session each year at participating fitness facilities, the option to work out at home with in-home fitness kits, and online fitness classes.
•  In-network coverage when you travel to Arizona, Florida, Georgia, North Carolina, South Carolina, and Tennessee (on HMO plans).
• Benefits and programs that can help you live healthy and stay independent, such as home safety products, in-home safety assessments, Tools for Caregivers, support for serious illness, post-discharge meals, and more.