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Medicare Advantage 

Medicare Advantage, also known as "Part C", are health insurance plans provided by private insurance carriers. Medicare Advantage plans do not supplement Medicare, they replace it. Advantage Plans provide hospital and doctor benefits just like Traditional Medicare, but will usually include extra's. These extra's can include prescription, dental, vision, and fitness club benefits. Medicare Advantage plans will also include manageable co-pays for medical care with caps on your out of pocket. The good news is that in many cases you can get all of these extra benefits for little or no extra monthly premium.

Key Benefits

Includes medical, Rx, & other extra benefits in one plan.

You pay $0 or a little more for these extra benefits. 

Helps you contain medical costs by providing limits & maximums.

Types Of Advantage Plans

Like traditional medical insurance, Advantage Plans have networks of medical providers. These networks are the doctors and hospitals that have a relationship with and accept the plan. Networks can be a good thing because they give you access to quality medical providers and help contain costs. There are several types of Medicare Advantage Plans but there are two that are the most common; PPO & HMO. The primary difference between the two lies in referral requirements and using in / out of network medical providers. The information below summarizes the two and their differences.

PPO Plan

Preferred Provider Org.

Has networks of doctors & hospitals and allows you to go out of network, but at higher co-pays.

Network restrictions do not apply to emergency and urgent care.

No referral is typically required to see specialists.

HMO Plan

Health Maintainance Org.

Has networks of doctors & hospitals and you must use them to be covered.

Network restrictions do not apply to emergency and urgent care.

Referrals from doctor required to see specialists.

Sample Advantage Plans

Below are sample plans that mirror many of the popular plans available in Texas. with various insurance providers. You will find that there are slight differences in rules for accessing doctors, benefits, and costs between HMO and PPO plans.

HMO Plan

Coverage for hospitalization, nursing facility, and other Part A  benefits.

Coverage for doctors, outpatient care, and other Part B benefits.

You'll need to use the plan's network of doctors except for emergency or urgent care.

Referrals are needed from your primary care doctor to see specialists.

Includes Part D prescription benefits and coverage for generic, brand, & specialty medications.

Dental, vision, & hearing aid benefits included.

No cost health club membership & exercise programs.

$0 monthly premium. You only pay the Medicare Part B premium.

$0 deductible or co-pay for annual preventive care and exams.

$0 deductible for diagnostic medical care, treatment, & tests; only co-pay's or coinsurance.

$0 primary doctor co-pay, $30 specialist, $90 emergency room.

PPO Plan

Coverage for hospitalization, nursing facility, and other Part A  benefits.

Coverage for doctors, outpatient care, and other Part B benefits.

This plan has a network of doctors & hospitals, but you can go out of network for higher co-pays.

No referral is needed from your primary care doctor to see specialists.

Includes Part D prescription benefits and coverage for generic, brand, & specialty medications.

Dental & vision benefits included.

No cost health club membership & exercise programs.

$18 monthly premium in addition to your Medicare Part B premium.

$0 deductible or co-pay for in network preventive care and exams.

$0 deductible for diagnostic medical care, treatment, & tests; only co-pay's or coinsurance.

$0 primary doctor co-pay, $40 specialist, $90 emergency room.

The examples above show sample features & benefits, which are not guaranteed. Contact us for details on plans & insurance providers available in your area.

Top Medicare Advantage Insurers

We help you compare plans & costs with these insurers in one convenient place. Scroll down this page to learn how.

Recommended Next Section: Medicare Part D

About Your Agent

Since beginning his career as a Licensed Insurance Agent, Ben Rodriguez has personally helped over 1,000 Medicare recipients. He has a degree in Business Finance from Kent State University and has acquired over 15 years of experience in financial services & insurance. Having a close relationship with his parents and grandparents has made him in tune to the needs of boomers and seniors.  Ben is known for his professionalism with a personal touch that he brings to each of his clients.

Ben Rodriguez

Licensed Agent

Agency Director 

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