Medically Reviewed By Alexander Nguyen, PharmD
— Written By Mandy French
Updated on May 15, 2025
Medicare Part C (Medicare Advantage) is an alternative to Original Medicare provided by Medicare-approved private insurance companies. All Part C plans must offer at least the same coverage as Original Medicare.
Many Part C plans include prescription drug coverage (Part D). The plans often include additional benefits not covered by Original Medicare.
Coverage, cost, and plan availability can vary by area.
Glossary of Medicare costs
- Out-of-pocket cost: This is what you pay for care when Medicare doesn’t cover the full cost or provide coverage. It includes premiums, deductibles, coinsurance, and copayments.
- Premium: This is the amount of money you pay each month for certain Medicare parts in order to receive health insurance coverage.
- Deductible: This is the amount you have to pay out of pocket annually before Medicare begins to cover healthcare costs.
- Coinsurance: This is the percentage of treatment costs you have to pay out of pocket. Coinsurance is typically 20% with Part B.
- Copayment: This is a fixed dollar amount you have to pay for certain services. With Medicare, this typically applies to prescription medications.
Medicare Part C inpatient coverage
Medicare Part C (Medicare Advantage) offers the same inpatient coverage as Medicare Part A:
- inpatient hospital care
- skilled nursing facilities
- inpatient behavioral and mental health services
- some home healthcare
- hospice care
The coverage of services and treatments during an inpatient hospital stay includes:
- semiprivate room
- general nursing
- meals
- medications you take while in the hospital
- other hospital services and supplies as part of inpatient treatment
» Learn more: Original Medicare vs. Medicare Advantage
Medicare Part C outpatient coverage
Medicare Part C (Medicare Advantage) offers the same outpatient coverage as Medicare Part B:
- outpatient care
- services from doctors and other healthcare professionals
- durable medical equipment (DME), such as wheelchairs, walkers, and hospital beds
- preventive services, such as vaccines and screenings
- some home healthcare
Other outpatient coverage includes:
- ambulance services, when medically necessary
- clinical research
- certain outpatient medications administered in a clinical setting, such as infusions and injections
- mental health and substance use disorders
- oxygen equipment and accessories
» Learn more: Medicare Part C (Medicare Advantage)
Medicare Part C prescription drug coverage
Most Medicare Part C (Medicare Advantage) plans include prescription drug coverage (Part D).
Prescription drug coverage includes many medications that people with Medicare may take. This coverage helps ensure people can receive the medication they need for conditions they may have.
Each prescription drug plan has a drug list, or formulary, that shows the prescription drugs it covers. Each plan must include at least two drugs in the most commonly prescribed classes and categories. However, plans can choose which drugs to include in their formularies, and whether they include brand-name and generic drugs.
All prescription drug plans must include most drugs in certain protected classes:
- HIV medications
- cancer drugs
- antidepressants
- antipsychotics
- anticonvulsants
- immunosuppressants for organ transplant
It’s a good idea to check a plan’s formulary before choosing your coverage.
» Learn more: Medicare Part D
Medicare Part C additional coverage
While all Medicare Part C (Medicare Advantage) plans must provide the same coverage as Original Medicare (parts A and B), many plans offer additional benefits. Original Medicare doesn’t cover many of those benefits.
The additional benefits include:
- fitness programs or gym memberships
- vision
- hearing
- dental
» Learn more: Pros and cons of Medicare Advantage
Medicare Part C costs
You must pay certain out-of-pocket costs. These include premiums, deductibles, and copayments.
Since private insurance companies set the costs for the plans they offer, the overall costs can vary by plan and area. Some plans may not have a monthly premium or a deductible.
However, even if you have a Medicare Part C (Medicare Advantage) plan, you still have to pay the Part B premium. In 2025, the standard Part B premium is $185.
Part C plans also have a maximum out-of-pocket (MOOP) limit that can change annually. While many plans may set this limit as less, the MOOP in 2025 can’t be more than $9,350. It’s the maximum amount you must pay out of pocket for your plan’s services before you pay nothing for your healthcare for the rest of the year.
Medicare resources
For more information to help guide you through the complex world of Medicare,visit our hub.
Summary
Medicare-approved private insurance companies administer Medicare Part C (Medicare Advantage) plans.
These plans must offer the same inpatient and outpatient coverage as Original Medicare (parts A and B). Part C plans also typically include prescription drug coverage (Part D).
The plans may offer additional benefits like vision, dental, and hearing.
