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Medicare Advantage Part C

Medicare Advantage, also known as "Part C", are health insurance programs provided by private insurance carriers that have a contract with Medicare. Medicare Advantage plans do not supplement Medicare, they replace it. Advantage Plans are required to provide the same basic benefits as Medicare A & B, 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 these benefits for little or no extra monthly premium than what you'll pay for Medicare.

Benefits

Includes A & B medical coverage plus extra benefits.

Manageable out of pocket medical costs.

Little or no extra monthly cost in addition to Medicare Part B.

Types Of Advantage Plans

Unlike Traditional Medicare, Medicare 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 help contain medical costs for health plans and their members. There are several types of Medicare Advantage Plans but two are the most common; PPO & HMO. The primary difference between the two lie in their requirements for seeing doctors and using in vs. out of network medical providers. The chart 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.

As mentioned earlier, Medicare Advantage plans include medical benefits with A & B, plus extra's. They can allow you to get medical care, prescriptions, and other care with reasonable out of pocket costs. Below are samples of the two main types of plans along with benefits and costs. 

Medicare Advantage Sample Benefits

PPO Plan

  • $15 monthly premium in addition to Part B.

  • Includes medical & prescription benefits.

  • $0 medical deductible for in network care.

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

  • $5 primary doctor co-pay, $40 specialist, $90 emergency room.

  • $6,700 annual cap on your medical expenses.

  • Basic dental & vision benefits included.

  • No cost health club membership.

HMO Plan

  • $0 monthly premium in addition to Part B.

  • Includes medical & prescription benefits.

  • $0 medical deductible.

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

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

  • $3,400 annual cap on your medical expenses.

  • Dental, vision, & hearing benefits included.

  • No cost health club membership.

Request a free, personalized plan comparison. Get details on plans in your area, including how they cover your medical, prescriptions, & doctors.

Recommended Next Section: Medicare Part D

About Your Agent

Throughout his career as a Licensed Insurance Agent, Ben Rodriguez has helped hundreds of Medicare recipients.  Since obtaining his degree in Business Finance from Kent State University, Ben has acquired nearly 15 years of experience in financial services and insurance.  Having a close relationship with his parents and grandparents has made him especially 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.

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We are an independent insurance agency that hundreds of Texans trust & rely on for their Medicare benefits. We specialize in Medicare Supplements, Medicare Advantage (Part C), Part D, and Dental & Vision plans. Our service is designed to be a one stop shop to make it easy for you to get your best value coverage. We are based in Austin, TX and offer plans in the entire state. Our services are provided to you conveniently by phone & online. 

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