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Medicare · Part C

Medicare Advantage, start to finish.

An all-in-one alternative to Original Medicare, run by private insurance companies. Here’s how it works, how it differs from a Supplement, and the three checks to make before you sign anything.

Compare & enroll with Simply Enroll

Before you choose, check the plan’s network, your doctors, and your prescriptions.

A brief overview

Medicare Advantage (Part C) Overview

Medicare Advantage plans, also known as Part C, are an alternative path to receiving your Medicare benefits. These plans are approved by Medicare but administered by private insurance companies.

When you choose a Medicare Advantage plan, you still have Medicare, but you receive your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage directly from the private health plan provider rather than the federal government. Most Medicare Advantage plans also include Medicare prescription drug coverage (Part D) built into the framework of the plan.

Eligibility for these plans requires that you are enrolled in both Medicare Part A and Part B and live within the specific plan’s service area. Enrollment periods are regulated by federal guidelines, typically aligning with your Initial Enrollment Period or the annual Open Enrollment Period.

Plan types

HMO, PPO, PFFS.

Same idea, three sets of rules about where you can go and whether you need a referral first.

HMOHealth Maintenance Organization
Care stays within the plan’s network, and you generally choose a primary care doctor who coordinates your care and refers you to specialists. Outside the network, coverage is usually limited to emergencies. In exchange, HMO plans often carry the lowest premiums of the three.
PPOPreferred Provider Organization
You can go outside the network and still be covered, though it costs you more than staying in. Referrals generally aren’t required, so you can go straight to a specialist. More freedom than an HMO, usually at a higher premium.
PFFSPrivate Fee-for-Service
The plan sets what it pays providers and what you pay. Any provider who accepts Medicare may treat you, but they can decide appointment by appointment whether to accept the plan’s terms, so it’s worth confirming before each visit. Less common than the other two.

Which of these are sold where you live varies by county, and so does the list of carriers offering them. There are other, less common plan types as well, including plans built for people with specific conditions or who also have Medicaid. Ask me what’s available at your address.

Compare

Want to know how Medicare Advantage compares to Medicare Supplement?

Here they are side by side. Nothing below is about price. It’s about how the two are built, which is what actually decides the fit.

Medicare Advantage (Part C)

How it works
Replaces Original Medicare as the way you get your Part A and Part B benefits. A private carrier administers the plan.
Seeing a doctor
Usually you use the plan’s network. Care outside it may cost more, or may not be covered at all; it depends on the plan type.
Referrals
HMO plans usually route you through a primary care doctor. PPO and PFFS plans generally don’t.
Prescription drugs
Many plans include Part D drug coverage in the same plan.
Extras
Some plans include benefits Original Medicare doesn’t cover, such as routine dental, vision, or hearing. What’s included varies by plan.
What you pay
Typically a lower monthly premium, with copays and coinsurance as you use care, up to the plan’s yearly out-of-pocket maximum.
Changing later
You can change plans during the Annual Enrollment Period each fall, and in some other qualifying situations.
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Medicare Supplement (Medigap)

How it works
Sits alongside Original Medicare and helps pay the share Original Medicare leaves to you, such as deductibles, copays, and coinsurance.
Seeing a doctor
Any provider in the country who accepts Medicare. There is no network to check.
Referrals
Not required. You keep Original Medicare’s rules.
Prescription drugs
Not included. You add a separate Part D plan; see Prescription Drugs.
Extras
None. Medigap does one job: covering Original Medicare’s cost-sharing.
What you pay
Typically a higher monthly premium, in exchange for fewer costs at the time you get care.
Changing later
Easiest when you first become eligible. Applying later can involve health questions, depending on your state and situation.
Read about Supplement

The right choice depends on your doctors, prescriptions, location, and budget. No single option fits everyone, so compare before you choose.

How to choose

Three things to check, in this order.

Do these before you compare premiums. A cheaper plan that doesn’t cover your cardiologist isn’t cheaper.

  1. Check The Plans Network

    Most plans have a local provider network. PFFS plans may not, so your providers must accept the plan’s terms. A plan available in the next county over may not be available in yours. Start by seeing which insurance companies offer plans where you live.

  2. Confirm Your Providers

    Verify that your doctors, specialists, and hospital is part of the plan’s network.

  3. Verify Prescription Coverage

    Each plan has its own drug list. It determines which medications are covered and how much you may pay. Reviewing your actual prescriptions and dosages is where plans that look identical may differ.

Once those three check out, enrolling is quick. You can do it yourself below, or call me and we’ll go through it together. The premium is identical either way.

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Questions

Questions About Advantage Plans

Do I still have Medicare if I join an Advantage plan?

Yes. You keep Medicare and keep paying your Part B premium; the plan becomes the way you receive your Part A and Part B benefits instead of receiving them directly from Medicare.

Can I have an Advantage plan and a Medigap policy?

No. They’re two different approaches to the same problem, and you choose one. A Medigap policy cannot be used to cover costs under a Medicare Advantage plan.

Do I need a separate Part D plan?

Usually Not. Many Medicare Advantage plans include prescription coverage in the plan. Some don’t, though, so it’s something to check rather than assume. If your plan includes it, you generally can’t add a separate Part D plan on top.

What if my doctor leaves the network?

Networks can change during the year. If your situation changes, reach out to me. The timing and circumstances may create options, and it’s always better to discuss them early rather than wait for the next enrollment period.

When can I change plans?

The Annual Enrollment Period (AEP), October 15 - December 7, is the main time to change plans. The Medicare Advantage Open Enrollment Period, January 1 - March 31, may allow changes if you’re already in an Advantage plan. Certain life events or eligibility changes may also open a Special Enrollment Period.

If your plan doesn’t include drug coverage

You’ll want to understand Part D before you decide, including the late-enrollment penalty, which is permanent once it applies.Read about prescription drug coverage.

Get in touch

Let’s check your doctors before you choose.

Have your prescriptions and your doctors’ names handy. Fifteen minutes on the phone will tell you more than an afternoon of comparing plans online.

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