The Truth About Medicare Part C: 5 Things You Should Know Before Enrolling in a Private Plan

Key Takeaways

• Medicare Part C, also known as Medicare Advantage, offers an alternative way to receive Medicare benefits through private insurance companies, but it comes with different rules, costs, and restrictions.

• While Medicare Advantage plans can provide additional benefits beyond Original Medicare, they also have network limitations and varying out-of-pocket costs, making it essential to compare options before enrolling.

Understanding Medicare Part C: What You Need to Know

Medicare Part C, commonly called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). It bundles hospital and medical coverage into a single plan, often including additional benefits like dental, vision, and hearing coverage. However, there are critical differences between Medicare Advantage and Original Medicare that can affect your healthcare access, costs, and flexibility.

Before you enroll, here are five important things you should know about Medicare Part C in 2025.

1. Medicare Advantage Is Offered by Private Companies

Unlike Original Medicare, which is run by the federal government, Medicare Part C plans are provided by private insurance companies approved by Medicare. This means:

• Each plan has its own set of rules, provider networks, and costs.

• Coverage can vary significantly depending on the plan and location.

• Plan availability changes annually, so reviewing your options during Open Enrollment is crucial.

Since private insurers administer Medicare Advantage, plan benefits and costs can change from year to year. If you enroll in a plan, you should review your Annual Notice of Change (ANOC) every fall to see if any adjustments could affect you.

2. Network Restrictions May Limit Your Choice of Providers

One major difference between Original Medicare and Medicare Advantage is provider flexibility. Medicare Advantage plans typically fall into one of these categories:

• Health Maintenance Organization (HMO) plans, which require you to use a network of doctors and hospitals. Out-of-network care is usually not covered except in emergencies.

• Preferred Provider Organization (PPO) plans, which offer more flexibility in choosing healthcare providers but still have network restrictions. Out-of-network care is covered but may cost more.

• Special Needs Plans (SNPs), which are tailored to specific health conditions or financial needs and come with their own network limitations.

If you prefer to see specific doctors or specialists, you should check whether they are in-network before choosing a Medicare Advantage plan.

3. Out-of-Pocket Costs and Coverage Vary by Plan

Medicare Advantage plans must cover everything Original Medicare does, but costs differ. Some key expenses include:

• Premiums: While some plans have low premiums, others charge monthly fees in addition to the Medicare Part B premium.

• Deductibles and Copayments: Unlike Original Medicare, which has standardized cost-sharing, Medicare Advantage plans set their own copayments, deductibles, and coinsurance amounts.

• Out-of-Pocket Maximums: Medicare Advantage plans have an annual cap on out-of-pocket costs for covered services, which can provide financial protection against high medical expenses.

In 2025, Medicare Advantage out-of-pocket maximums remain an important factor in plan selection, as they limit how much you pay for covered services each year.

4. Additional Benefits Can Be a Plus – But Read the Fine Print

One reason many people choose Medicare Advantage is the extra benefits that Original Medicare doesn’t cover, such as:

• Dental care, including routine cleanings and dentures

• Vision coverage, including glasses and contacts

• Hearing aids and hearing exams

• Fitness memberships or wellness programs

• Prescription drug coverage (in most plans)

While these benefits can be attractive, they are not standardized across all plans. Some plans may offer robust dental and vision coverage, while others provide only minimal benefits. Always check the details before enrolling to ensure a plan meets your specific needs.

5. Medicare Advantage Enrollment Is Limited to Certain Times

You can’t sign up for or switch Medicare Advantage plans anytime you want. Instead, you must enroll during specific enrollment periods:

• Initial Enrollment Period (IEP): This 7-month window begins three months before you turn 65, includes your birth month, and lasts for three months after.

• Medicare Open Enrollment (October 15 – December 7): During this period, you can switch between Medicare Advantage and Original Medicare, or change from one Medicare Advantage plan to another.

• Medicare Advantage Open Enrollment (January 1 – March 31): If you’re already enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare.

• Special Enrollment Periods (SEP): These apply if you experience qualifying life events, such as moving to a new area, losing employer coverage, or qualifying for Medicaid.

Missing an enrollment period can result in waiting until the next Open Enrollment to make changes, so it’s important to plan ahead.

What You Should Consider Before Choosing Medicare Advantage

Medicare Advantage can be a great option for some people, but it’s not right for everyone. Consider these factors when deciding:

• Do you prefer lower monthly costs or lower out-of-pocket expenses when receiving care? Some plans have lower premiums but higher copayments, while others have higher premiums with lower costs when you receive services.

• Are your preferred doctors and hospitals in-network? If not, you may face higher costs or need to switch providers.

• Do you need additional benefits? If vision, dental, hearing, or fitness benefits are important to you, Medicare Advantage may be a good fit.

• Do you travel frequently? Medicare Advantage plans typically have regional networks, so Original Medicare may be better if you travel often.

How to Find the Right Medicare Plan

With so many Medicare Advantage plans available, comparing them can be overwhelming. To simplify the process:

1. Make a list of your must-have benefits and provider preferences.

2. Compare plan options in your area. Costs and coverage vary widely, so research multiple plans.

3. Check network providers. Ensure your doctors, hospitals, and specialists accept the plan.

4. Review out-of-pocket costs. Look beyond premiums to see what you’ll pay for doctor visits, hospital stays, and prescriptions.

5. Read plan documents carefully. Review the Summary of Benefits and Evidence of Coverage for detailed information.

If you’re still unsure about which plan is best for you, reach out to a Medicare professional listed on this website. They can guide you through the process and help you make an informed decision based on your healthcare needs.