What Is Medicare Part C? Medicare Advantage Explained
Reviewed October 7, 2026. Medicare Part C is the same thing as Medicare Advantage. It’s a Medicare-approved health plan from a private insurance company that you can choose instead of Original Medicare (Parts A and B) (Medicare.gov). The plan must cover everything Original Medicare covers, usually bundles in Part D drug coverage, and often adds extras like dental, vision and hearing.
Quick answer: Part C is not a separate type of insurance you add to Medicare; it’s another way to get your Part A and Part B benefits. You still pay your Part B premium ($202.90 a month in 2026), you generally use the plan’s provider network, and you’re protected by a yearly out-of-pocket limit on covered medical services.
Is Medicare Part C the same as Medicare Advantage?
Yes. “Part C” is the name of the section of Medicare law that created these plans, and “Medicare Advantage” is what they’re called in plan materials and on Medicare.gov. Plans offered by companies such as Humana, UnitedHealthcare, Aetna and others are all Part C plans. Medigap (Medicare Supplement) is different: it works alongside Original Medicare and can’t be used with a Medicare Advantage plan.
How Medicare Advantage works
- You must have Medicare Part A and Part B and live in the plan’s service area.
- Medicare pays the private plan a set amount each month to provide your coverage, and the plan pays your doctors and hospitals.
- Plans must cover all medically necessary services that Original Medicare covers. Original Medicare still covers hospice care if you need it (Medicare.gov).
- You use your plan’s card, not your red, white and blue Medicare card, to get care.
- Most plans include Part D drug coverage. In 2026 your out-of-pocket costs for covered drugs are capped at $2,100 (CMS).
- Every plan has a yearly limit on what you pay for covered Part A and Part B services. Once you reach it, you pay nothing for covered services for the rest of the year.
- You’re always covered for emergency and urgent care, in or out of network.
Types of Medicare Part C plans
| Plan type | How it works |
|---|---|
| HMO (Health Maintenance Organization) | You generally must use doctors and hospitals in the plan’s network except in emergencies; many HMOs require referrals to see specialists |
| PPO (Preferred Provider Organization) | You can see out-of-network providers, but you pay less in network |
| PFFS (Private Fee-for-Service) | The plan sets what it pays providers; you can see any provider who agrees to the plan’s terms |
| SNP (Special Needs Plan) | For people with Medicaid, certain chronic conditions, or who live in an institution; benefits are tailored to the group |
| MSA (Medical Savings Account) | A high-deductible plan paired with a savings account that Medicare deposits money into |
Source: Understanding Medicare Advantage Plans. Compare the two most common types in Medicare Advantage HMO vs PPO, and learn about Special Needs Plans.
Medicare Part C vs. Original Medicare
| Original Medicare (Parts A and B) | Medicare Advantage (Part C) | |
|---|---|---|
| Who runs it | The federal government | Private insurers approved by Medicare |
| Doctors | Any provider in the U.S. that accepts Medicare | Usually a plan network; rules vary by plan type |
| Referrals and prior authorization | Generally not required | Often required for specialists and certain services |
| Yearly out-of-pocket limit | None unless you buy a Medigap policy | Yes, for covered Part A and B services |
| Drug coverage | Add a separate Part D plan | Usually included |
| Extra benefits (dental, vision, hearing) | Mostly not covered | Often included, varies by plan |
| Monthly cost | Part B premium, plus Medigap and Part D premiums if you buy them | Part B premium, plus the plan premium (some plans charge $0) |
Weighing the trade-offs? Read pros and cons of Medicare Advantage and see what Medicare Advantage dental coverage typically includes.
What Medicare Part C costs in 2026
- Part B premium: You keep paying it, $202.90 a month in 2026 for most people (Medicare.gov). Some plans offer a Part B giveback that lowers it.
- Plan premium: Set by the plan; many plans charge $0 in some areas.
- Copays, coinsurance and deductibles: Set by the plan for doctor visits, hospital stays, drugs and other services.
- Out-of-pocket maximum: Set by the plan, up to a federal limit. Check the plan’s Summary of Benefits.
When you can join or switch a Part C plan
| Enrollment period | Dates | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around your 65th birthday | Join a Medicare Advantage plan when you first get Medicare |
| Open Enrollment | October 15 to December 7 | Join, switch or drop a Medicare Advantage plan for January 1 coverage |
| Medicare Advantage Open Enrollment | January 1 to March 31 | If you’re in a Medicare Advantage plan, switch to another one or go back to Original Medicare |
| Special Enrollment Periods | Varies | After certain events, like moving out of your plan’s service area |
Source: Medicare.gov. Open Enrollment for 2027 coverage starts October 15, 2026. See our Medicare open enrollment guide. If you later want to leave, read how to switch from Medicare Advantage to Medigap, since you may not get Medigap without medical underwriting outside certain protected times.
Frequently asked questions
What is Medicare Part C in simple terms?
It’s Medicare Advantage: a private plan approved by Medicare that replaces Original Medicare for your hospital and medical coverage, and usually includes drug coverage.
Is Medicare Part C free?
Some plans have a $0 monthly premium, but you still pay your Part B premium and the plan’s copays, coinsurance and deductibles when you get care.
Do I need Part A and Part B to get Part C?
Yes. You must be enrolled in both Part A and Part B and live in the plan’s service area.
Can I have Medigap and Part C at the same time?
No. Medigap only works with Original Medicare. It’s illegal for anyone to sell you a Medigap policy if you’re in a Medicare Advantage plan, unless you’re switching back to Original Medicare.
Does Medicare Part C cover prescription drugs?
Most plans do. If your plan doesn’t include drug coverage, you generally can’t add a stand-alone Part D plan unless it’s a certain type of plan, such as a PFFS or MSA plan.
Can I use any doctor with Part C?
It depends on the plan. HMOs generally require in-network providers except for emergencies; PPOs let you go out of network for a higher cost.
This article is general information, not legal, tax or individual insurance advice. Plan rules and costs can change each year, so confirm details with Medicare, Social Security or your plan. Medicare365 is not affiliated with or endorsed by the U.S. government or the federal Medicare program.