Medicare Advantage Plans

Understanding Medicare Part C — your all-in-one alternative to Original Medicare

What is Medicare Advantage (Part C)?

Medicare Advantage — also known as Medicare Part C — is an alternative way to receive your Medicare benefits. Instead of getting coverage directly from the federal government through Original Medicare (Parts A and B), you get your coverage through a private insurance company approved by Medicare.

Medicare Advantage plans must cover everything that Original Medicare covers, but they often include additional benefits like prescription drug coverage (Part D), dental, vision, hearing, and wellness programs — sometimes at little or no extra cost.

To enroll in a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Part B and live in the plan's service area.

Types of Medicare Advantage Plans

HMO— Health Maintenance Organization

You must use doctors and hospitals in the plan's network, except in emergencies. You typically need a primary care physician (PCP) and referrals to see specialists.

Best for: People who want lower premiums and don't mind using a network.

PPO— Preferred Provider Organization

You can use any doctor or hospital, but you pay less when you use in-network providers. No referrals required to see specialists.

Best for: People who want more flexibility in choosing providers.

PFFS— Private Fee-for-Service

The plan determines how much it will pay doctors and hospitals, and how much you pay. You can see any Medicare-approved provider who agrees to the plan's terms.

Best for: People in rural areas with limited network options.

SNP— Special Needs Plan

Designed for people with specific diseases or characteristics. Membership is limited to people with certain chronic conditions, dual eligibility (Medicare and Medicaid), or who live in institutions.

Best for: People with chronic conditions like diabetes, heart disease, or ESRD.

Pros and Cons of Medicare Advantage

Advantages

Often $0 or low monthly premiums
May include extra benefits (dental, vision, hearing, fitness)
Prescription drug coverage usually included (Part D)
Annual out-of-pocket maximum limits your costs
Care coordination through a primary care physician

Disadvantages

Must use plan's network of doctors and hospitals
May require referrals to see specialists
Coverage rules and costs can change each year
May not be accepted everywhere (unlike Original Medicare)
Prior authorization may be required for some services

Medicare Advantage vs. Medicare Supplement

The choice between Medicare Advantage and a Medicare Supplement (Medigap) plan is one of the most important decisions you'll make about your healthcare. Both have their advantages, and the right choice depends on your health needs, budget, and lifestyle.

Medicare Advantage plans often have lower monthly premiums but may have higher out-of-pocket costs when you need care. Medicare Supplement plans typically have higher premiums but offer more predictable costs and greater flexibility in choosing providers. Our licensed agents can help you compare both options side by side.

Not sure which plan is right for you?