Medicare is a federal health insurance program that covers millions of Americans. In general, you are eligible for Medicare if you are 65 or older, or you are younger than 65 and meet criteria for certain disabilities, or have End-Stage Renal Disease (ESRD).
Medicare Part C: Medicare Advantage
A Medicare Part C plan, also known as Medicare Advantage, is offered by private insurers. If you choose Medicare Part C you will generally have access to services in addition to all services covered by Parts A and B. Under Medicare Advantage you likely will pay a copayment for covered services and see doctors in the plan’s network.
In addition to all services under Medicare Part A and Medicare Part B, many Medicare Advantage plans typically cover the following:
• emergency and urgent care
• vision services
• hearing services
• dental services
• health and wellness programs
• Medicare Part D prescription drug coverage
In most cases, you may join a Medicare Advantage plan if you are entitled to Part A and enrolled in Part B, if you live in the plan’s service area, and if you do not have end-stage renal disease (ESRD).
Types of plans
Considering a Medicare Advantage plan? There are many Medicare options. But generally speaking, the plan types can be broken down as follows:
Medicare Advantage HMO plans
• may offer benefits in addition to Original Medicare (Parts A and B)
• may include Medicare Part D prescription drug coverage
• feature a network of providers that you must use for your care in most cases
• require that if you visit out-of-network providers, you are usually responsible for the costs
Medicare Cost plans
Medicare Cost plans are available in certain areas of the country. In a Cost plan, if you go to a non-network provider, the services are covered under Original Medicare. You would pay the Part B premium, and a monthly health plan premium (if applicable). If you seek services out of the plan’s network, you also pay any applicable Part A and Part B coinsurance and deductibles.
Like Medicare Advantage, a Medicare Cost plan may offer benefits in addition to Original Medicare (Parts A and B) and may include Medicare Part D prescription drug coverage.
In a Cost plan you can do the following:
• join even if you only have Part B
• join anytime the plan is accepting new members
• leave anytime and return to Original Medicare
• either get your Medicare prescription drug coverage from the plan (if offered), or join a Medicare prescription drug plan (PDP) to add prescription drug coverage (note: Part D coverage can only be added or dropped during a valid enrollment period)
Medicare Special Needs Plan (SNP)
The SNP is a type of Medicare Advantage plan for people with additional health care needs or limited incomes. You may be eligible for a Special Needs Plan if you:
• live with a chronic or disabling condition
• live in a nursing home or other institution (or require an institutional level of care)
• are eligible for both Medicare and state Medicaid benefits (called Medi-Cal benefits in California)
Other Medicare coverage
There are other options available for your Medicare coverage, including Medicare preferred provider organization (PPO) plans, Medicare private fee-for-service (PFFS) plans, and Medicare medical savings account (MSA) plans.
For more information
See our sections on Medicare eligibility and enrollment.
You can enroll in Medicare Part C plans and Cost plan Part D coverage only during certain times of the year or based on certain limited special circumstances.
Visit the Medicare website † or call 1-800-MEDICARE (1-800-633-4227) (toll free) or 1-877-486-2048 (toll-free TTY for the hearing/speech impaired), 24 hours a day, 7 days a week. Or visit your local Social Security office, or call Social Security at 1-800-772-1213 (toll free) or 1-800-325-0778 (toll-free TTY for the hearing/speech impaired), Monday through Friday, 7 a.m. to 7 p.m.