Medicare
Medicare Advantage (Part C)
One card, one plan, one set of rules — with a network to stay inside and a yearly cap on what you can be asked to pay.
How it works
A Medicare Advantage plan is offered by a private insurance company under contract with Medicare. When you enroll, that plan takes over how you receive your Part A and Part B benefits. You keep paying your Part B premium; the plan may charge an additional premium, and in many counties that additional premium is zero.
Instead of Medicare’s 20% coinsurance, you pay set copays as you use care — so much for a primary care visit, so much for a specialist, so much per day for a hospital stay. Those copays add up to an annual out‑of‑pocket maximum, after which the plan pays 100% of covered services for the rest of the year. Original Medicare by itself has no such cap, and that ceiling is the main reason people choose these plans.
What the plan types mean
- HMO — you use the plan’s network and usually pick a primary care doctor who refers you to specialists. Out‑of‑network care is generally not covered except in an emergency.
- PPO — you may go out of network at a higher cost, and referrals are usually not required.
- Special Needs Plans (SNP) — built for people with a specific condition, or those who have both Medicare and Medicaid. Eligibility rules apply.
Extra benefits
Many Medicare Advantage plans include benefits Original Medicare does not cover. Depending on the plan and the county, coverage for dental, vision, hearing, a fitness membership, an over‑the‑counter allowance, or transportation may be available.
These extras vary widely, come with their own limits, and can change from one year to the next. Before you count on one, we read the plan’s own benefit documents with you rather than the television ad.
The honest trade‑offs
These plans fit a lot of people very well and fit others poorly. The difference usually comes down to how you use care and how far you travel.
Often a good fit when
- Your doctors are already in the plan’s network.
- You want a lower monthly premium and can handle copays as they come.
- You value having drug coverage and extras bundled into one plan.
- You stay in your home area most of the year.
Often a poor fit when
- You split the year between states or travel constantly.
- You see specialists at a center that is out of network.
- You would rather pay a predictable premium than variable copays.
- You do not want prior authorization involved in your care.
Questions we hear about Advantage plans
If I join, am I still in Medicare?
Yes. You remain enrolled in Medicare and keep paying your Part B premium. The plan administers your benefits under contract with Medicare.
What is prior authorization?
For certain services the plan requires approval before it will cover the care. It is a real difference from Original Medicare and worth knowing about in advance, particularly if you expect imaging, surgery, or a skilled nursing stay.
Can I go back to Original Medicare later?
You can change during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period. The complication is the supplement: outside your one‑time supplement open enrollment window, in most states a company may use medical underwriting and can decline you. That is why the first decision deserves care.
Let us run your doctors and drugs through the plans in your county.
It takes a few minutes and it is the only way to know whether a plan actually works for you.
By calling this number, you will be connected with a licensed insurance agent who can answer questions about the plans we offer. There is no cost or obligation to talk.