Medicare Part C: What Does It Cover?

If you’re wondering, “Medicare Part C, what does it cover?”—you’re not alone. Medicare can be confusing, but understanding your options is crucial to making the best healthcare decisions. As a Medicare expert, I’m here to break it all down in a clear and relevant way to your situation.

Medicare Part C, also known as Medicare Advantage, is a private insurance alternative to Original Medicare (Parts A & B). These plans, approved by Medicare, bundle hospital (Part A) and medical (Part B) coverage—often adding extra benefits that Original Medicare doesn’t cover. Think of it as an all-in-one Medicare package!

The Centers for Medicare & Medicaid Services (CMS) contracts with private insurance companies to create Medicare Part C plans. These insurers must follow CMS rules, ensuring their plans provide coverage at least as good as Original Medicare. If an insurance company fails to meet these standards, they risk losing their contract and clients and even facing penalties for noncompliance.

One of the most significant advantages of Medicare Part C is that it generally covers everything included in Original Medicare—plus more! Here’s what you can expect:

Many Medicare Part C plans include Part D prescription drug coverage. If you take medications regularly, having drug coverage built into your plan can be a major advantage.

In the Omaha, Bellevue, Lincoln, & Council Bluffs areas, most of the plans include drug coverage at no additional cost and most of the advantage plans are zero premium and some with no deductible. Good way to cover medications at the cost of zero premium versus stand-alone Part D plans with premium and deductible.

Original Medicare doesn’t cover routine vision, dental, or hearing services, but many Medicare Part C plans do! This can include:

Love staying active? Many Medicare Part C Advantage plans offer SilverSneakers or other wellness programs that give you free access to gyms, fitness classes, and wellness coaching.

Medicare Advantage plans emphasize wellness and preventive services as a way to keep costs down.

Some plans offer allowances for over-the-counter medications and health products like toothpaste, pain relievers, bandages, and vitamins—saving you money on everyday essentials.

For those who can’t drive, some Medicare Part C Advantage plans offer non-emergency transportation to doctor, dental, vision, and therapy appointments.

Virtual doctor visits have become more common, and Medicare Advantage plans often include telehealth services—perfect for when you can’t (or don’t want to) leave home.

While Medicare Part C is comprehensive, it does not cover everything. Some exclusions include:

Medicare Part C costs vary by plan, provider, and location. Most Medicare Advantage plans in Omaha, Bellevue, Lincoln, and Council Bluffs have $0 premiums, though few have small monthly costs.

While Medicare Advantage typically has lower monthly costs than Original Medicare with a Medicare Supplement, you pay copays when you use services and have a maximum out-of-pocket limit for protection during high-cost years.

To better understand your costs, you can use a Medicare Part C cost calculator to compare expenses.  You can find it on Medicare.gov, or we also have much more user-friendly software that can lay out your potential costs on all available plans.

Medicare Advantage plans operate as managed care, using provider networks (HMO, PPO, etc.) to manage costs and services. While Omaha-area Medicare Advantage plans offer broad access to providers, networks can be restrictive in other areas.

Original Medicare operates as a Fee-for-Service (FFS) system, allowing beneficiaries to see any doctor or hospital in the U.S. that accepts Medicare—no network restrictions! However, Medicare Part C eligibility includes additional benefits like dental, vision, and hearing, which Original Medicare does not cover.

Prior authorization requires your provider to get approval from your insurance company (or Medicare) before covering specific procedures, medications, or services.

Medicare Part C plans almost always require prior authorization for:

Original Medicare rarely requires prior authorization, except for:

While Original Medicare requires separate premiums for a Medigap plan and Part D prescription drug coverage, Medicare Part C typically bundles these benefits—often at no additional premium.

Medicare Advantage plans limit your maximum out-of-pocket costs, providing financial protection that Original Medicare lacks. With Medicare Part C Advantage plans, you trade higher monthly premiums for lower overall expenses.

✅ No network restrictions

✅ Fixed monthly premiums

✅ No prior authorization worries

❌ Higher monthly costs

❌ No built-in extra benefits

✅ Low or $0 premiums
✅ Extra benefits (dental, vision, hearing)
✅ Maximum out-of-pocket protection
❌ Potential network restrictions
❌ Possible prior authorization delays

Medicare Part C offers comprehensive coverage, cost savings, and additional benefits, but it operates differently than Original Medicare. Choosing the right plan depends on your healthcare needs, budget, risk tolerance, and provider preferences.

📞 Need help choosing a plan? Let’s chat! Call 402-614-3389 or email Chris@OmahaInsuranceSolutions.com to speak with a local licensed insurance agent professional for expert Medicare guidance!