What Is Medicare Part C? How Medicare Advantage Works in Utah

Sources: Medicare.gov: Your health plan options · Medicare.gov: Compare Original Medicare & Medicare Advantage

Medicare's letters can be confusing, and "Part C" is a common question. This guide explains what Medicare Part C is, what it covers, the five plan types, who can join, and when. There's an interactive plan-type explainer partway down.

New to Medicare? Start with turning 65 in Utah and how to apply for Medicare in Utah, since you need Part A and Part B before you can join a Part C plan.

What is Medicare Part C?

Medicare has four parts. Part A is hospital insurance, Part B is medical insurance, Part D is drug coverage, and Part C is Medicare Advantage, another way to get your Part A and Part B coverage (Medicare.gov).

With Original Medicare, the federal government pays your claims, and you can see any doctor or hospital in the U.S. that takes Medicare. With Medicare Advantage, you join a plan offered by a Medicare-approved private company that must follow Medicare's rules. The plan covers your Part A and Part B services, usually through a network and service area.

Is Medicare Part C the same as Medicare Advantage?

Yes. "Medicare Part C," "Medicare Advantage" and "MA plan" all mean the same thing. You'll see both names on Medicare.gov and in plan materials.

What does Medicare Part C cover?

Every Medicare Advantage plan must cover all the medically necessary services that Original Medicare covers (Medicare.gov). Beyond that, plans differ:

• Drug coverage: most plans include Part D, so you don't join a separate drug plan.
• Extra benefits: some plans add benefits Original Medicare doesn't cover, like some vision, hearing and dental services.
• Rules for getting care: you may need to use the plan's network, get a referral to see a specialist, or get approval (prior authorization) before certain services.
• Travel: plans generally don't cover care outside the U.S., though some add emergency coverage when you travel abroad.

What does Medicare Part C cost?

We don't show prices here, because costs vary by plan and county. Here's how the costs are built:

• Part B premium: you keep paying it. The standard amount is $202.90 a month in 2026 (CMS).
• Plan premium: some plans charge their own premium, and some help pay part of your Part B premium.
• Copays, coinsurance and deductibles: these vary by plan and by service.
• Yearly out-of-pocket limit: every plan has a yearly limit on what you pay for covered Part A and Part B services, and some plans have separate in-network and out-of-network limits. Once you reach your plan's limit, you pay nothing more for covered Part A and Part B services for the rest of the calendar year. Plan premiums, Part D drug costs and care the plan doesn't cover don't count toward the limit.

Higher income? Your Part B and drug premiums may include IRMAA. See IRMAA brackets 2027.

Types of Medicare Advantage plans

Medicare.gov lists five types of Medicare Advantage plans. They differ mostly in how you use doctors and how drug coverage works (Medicare.gov).

• HMO (Health Maintenance Organization): you generally get care from the plan's network, except emergency care, out-of-area urgent care and temporary out-of-area dialysis. You usually choose a primary care doctor and need referrals. Some HMOs are Point-of-Service (HMO-POS) plans that allow some out-of-network care.
• PPO (Preferred Provider Organization): the plan has a network, and you can generally go out of network for covered services, usually at a higher cost share. No referrals needed.
• PFFS (Private Fee-for-Service): you can go to any Medicare-approved provider that accepts the plan's payment terms and agrees to treat you.
• SNP (Special Needs Plan): for people who qualify, such as people with both Medicare and Medicaid, certain chronic conditions, or who live in an institution. All SNPs include drug coverage.
• MSA (Medical Savings Account): a high-deductible plan paired with an account the plan deposits money into each year. It generally has no network and doesn't include drug coverage.

Medicare Advantage plan type explainer

Pick a plan type to see how it usually works, with a question to ask. Use "Compare all 5" to see them together.

Who can join a Medicare Part C plan?

To join a Medicare Advantage plan, you generally need to have Part A and Part B and live in the plan's service area (Medicare.gov). Special Needs Plans have extra rules about who qualifies.

Medicare Part C vs Original Medicare

The big trade-off is how you use doctors and how costs work. Original Medicare works with any doctor or hospital in the U.S. that takes Medicare, usually without referrals, but it has no yearly out-of-pocket limit on its own. Medicare Advantage usually uses a network and may require referrals and prior approval, and it has the yearly limit described above. See both side by side in our Original Medicare vs. Medicare Advantage comparison tool.

People in Original Medicare can add a Medigap policy. Learn how that works in What is Medigap?, with a closer look at two letters in Plan G vs Plan N and Medicare Supplement Plan N. Remember that Medigap can't be used with a Medicare Advantage plan. We compare the two coverage styles in Medicare Advantage vs. Medicare Supplement.

Medicare Part C vs Part D

Part D is drug coverage only. You can get it as a stand-alone drug plan with Original Medicare, or built into most Medicare Advantage plans. If you're in an HMO or PPO that offers drug coverage, you get your drugs through that plan rather than a separate drug plan. Read about the Part D out-of-pocket cap.

When can you join a Medicare Advantage plan?

• When you're first eligible: during your 7-month Initial Enrollment Period around your 65th birthday. See Medicare enrollment dates.
• Every fall: during Medicare Open Enrollment, October 15 to December 7, you can join, switch or drop a Medicare Advantage plan. Changes start January 1.
• January to March: if you're already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (January 1 to March 31) lets you make one change. You can switch to a different Medicare Advantage plan, or drop your plan and go back to Original Medicare and join a separate Medicare drug plan. If you switch to Original Medicare, a Medigap company may ask health questions, charge more or turn you down outside your Medigap Open Enrollment Period, unless you have a guaranteed issue right, such as a trial right if you joined Medicare Advantage when you were first eligible at 65 and leave within the first year.
• After certain life events: moving or losing other coverage may give you a Special Enrollment Period.

How to join a Medicare Advantage plan

How our team helps

We're Boo Insurance Services, a licensed independent Medicare agency in Draper, licensed since 2014. We've helped 1,000+ Utahns with Medicare and have 170+ 5-Star Google Reviews. We meet by phone or video anywhere in Utah, check your doctors and prescriptions, and explain how Medicare Advantage and Original Medicare work in plain language. You decide, with no obligation.

Frequently asked questions

What is Medicare Part C in simple terms?

Medicare Part C, also called Medicare Advantage, is a Medicare-approved plan from a private company that covers your Part A and Part B services instead of Original Medicare. Most plans also include drug coverage.

Is Medicare Part C the same as Medicare Advantage?

Yes. Medicare Part C and Medicare Advantage are two names for the same type of coverage.

Do I still pay the Part B premium with Medicare Part C?

Yes. You keep paying your Part B premium. Some plans also charge their own premium, and some help pay part of the Part B premium.

What's the difference between Medicare Part C and Part D?

Part C is Medicare Advantage, which covers your hospital and medical services and usually drugs too. Part D is drug coverage only, offered as a stand-alone drug plan or built into most Medicare Advantage plans.

Does Medicare Part C have an out-of-pocket limit?

Yes. Every plan has a yearly limit on what you pay for covered Part A and Part B services, and some plans have separate in-network and out-of-network limits. Once you reach it, you pay nothing more for covered Part A and Part B services for the rest of the calendar year. Premiums, Part D drug costs and non-covered care don't count toward it.

Can I use a Medigap policy with Medicare Part C?

No. Medigap can't be used with a Medicare Advantage plan. Medigap works only with Original Medicare.

Who can join a Medicare Part C plan?

Generally, anyone with Part A and Part B who lives in the plan's service area. Special Needs Plans have extra rules about who qualifies.

Are Medicare Part C plans the same everywhere in Utah?

No. Plans are offered by county service area, so the plans, networks and extra benefits can differ between counties. Original Medicare works the same in every Utah county.

Serving Utah residents. We do not offer every plan available in your area. Currently we represent 9 organizations which offer 58 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Sources

• Medicare.gov, Your health plan options
• Medicare.gov, Compare types of Medicare Advantage Plans
• Medicare.gov, Compare Original Medicare & Medicare Advantage
• Medicare.gov, Joining a plan and Special Enrollment Periods
• CMS, 2026 Medicare Parts A & B Premiums and Deductibles
• CMS, Medicare Monthly Enrollment (Utah counties, June 2026)
• SSA, Sign up for Medicare

Not connected with or endorsed by the United States government or the federal Medicare program. Fores Boo, licensed independent Medicare agent, NPN 17255694, Boo Insurance Services, 61 W 13490 S Ste 201, Draper, UT 84020.

Last updated: October 21, 2026.