Comprehensive Care in One Simple Plan: Medicare Advantage

Understand Part C, compare local HMO and PPO networks, and find the right balance of freedom, benefits, and affordability.

Get Started

What is Medicare Part C (Medicare Advantage)?

Medicare Advantage—often called Medicare Part C—is an all-in-one alternative to Original Medicare offered by Medicare-approved private insurance companies.

Instead of managing separate policies, Part C bundles Part A (Hospital Insurance) and Part B (Medical Insurance) into a single plan. In addition, most Medicare Advantage plans include Part D prescription drug coverage and extra routine benefits that Original Medicare does not cover.

Key Benefits of Medicare Advantage

All-in-One Convenience: Combine hospital, medical, and prescription drug coverage into one plan with a single member ID card.

Added Everyday Benefits: Most plans feature coverage for routine dental, vision, hearing exams, and wellness or fitness allowances.

Financial Protection: Unlike Original Medicare, every Medicare Advantage plan has an annual Maximum Out-of-Pocket (MOOP) limit. Once reached, the plan pays 100% of covered medical costs for the rest of the year.

Low-to-$0 Monthly Premiums: Many plans offer low or $0 additional monthly plan premiums, though you must continue paying your standard Part B premium.

Understanding Network Types: HMO vs. PPO

Medicare Advantage plans rely on specific provider networks. Choosing between an HMO and a PPO comes down to whether you prioritize lower out-of-pocket costs or greater flexibility to choose your doctors.

Feature
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Provider Network
Requires using doctors, hospitals, and pharmacies inside the plan network (except emergency care).
Offers access to both in-network and out-of-network providers.
Specialist Referrals
Typically requires a referral from your Primary Care Physician (PCP).
Usually no referral needed to see a specialist.
Out-of-Pocket Costs
Generally offers lower copays, coinsurance, and premiums.
Higher copays/coinsurance if choosing out-of-network care.
Primary Care Physician (PCP)
Usually mandatory to designate a PCP to coordinate care.
Often optional; freedom to book care directly.
Best For
Beneficiaries comfortable with local networks looking for maximum cost savings.
Beneficiaries who travel often or want flexibility with specialists and clinics.

Is Medicare Advantage Right for You?

Before enrolling, review these key considerations:

Doctor & Hospital Networks: Make sure your preferred primary care doctors, specialists, and regional health systems are in-network.

Formulary (Prescription List): Confirm your current medications are included on the plan's formulary at affordable tiers.

Travel Habits: If you split your time between two states or travel frequently, confirm whether out-of-network or multi-region coverage applies.

When Can You Enroll?

Initial Enrollment Period (IEP): The 7-month window around your 65th birthday (3 months before, your birthday month, and 3 months after).

Annual Enrollment Period (AEP): October 15 – December 7 every year to join, switch, or drop a Medicare Advantage plan.

Medicare Advantage Open Enrollment (MA OEP): January 1 – March 31 to switch to another Medicare Advantage plan or return to Original Medicare if already enrolled.

Special Enrollment Periods (SEP): Available if you experience qualifying life changes, such as moving out of your plan's service area or losing employer-sponsored coverage.

Check If Your Doctors & Medications Are Covered

Network details and benefit tiers vary by county. Speak with an independent advisor to compare Medicare Advantage options available in your local area.

Schedule a Free Review