Medicare Advantage (Part C)

The All-in-One Alternative to Original Medicare

Medicare Advantage plans, also called Part C, are private health insurance plans approved by Medicare. They bundle your Part A (Hospital) and Part B (Medical) coverage, and some include Part D (prescription drug coverage). Most Medicare Advantage plans also offer extra benefits Original Medicare doesn’t cover, such as dental, vision, hearing, fitness, and more.

Think of Medicare Advantage as the all-in-one alternative to Original Medicare.

What Medicare Advantage Can Include

All the benefits of Original Medicare (Parts A & B)

  • Prescription drug coverage (Part D)

  • Extra benefits such as dental, vision, hearing, and fitness programs

  • Out-of-pocket maximum protection (something Original Medicare doesn’t have)

What to Keep
in Mind

  • Many Advantage plans are marketed as $0 premium plans. While this is true for some, it depends on where you live and the plan you choose.

  • Plans vary widely by carrier and region, so the “best plan” for your neighbor, family member, or even spouse may not be right for you.

  • Medicare Advantage works well for many people, but not everyone. Comparing your options is key.

Types of Medicare Advantage Plans

  • HMO (Health Maintenance Organization)

    • Lower costs, but you’ll need to stay in-network and usually need referrals for specialists.

      • Good fit if your doctors are in-network and you don’t travel much.

  • PPO (Preferred Provider Organization)

    • Higher flexibility. You can go out of network at higher cost. No referrals needed

      • Good fit if you want more choice and don’t mind paying a bit extra depending on location.

  • SNP (Special Needs Plans)

    • Tailored for people with certain chronic conditions, those in nursing facilities, or those who qualify for both Medicaid and Medicare (known as Dual Special Needs Plan, or DSNP).

  • MSA (Medical Savings Account)

    • High deductible health plan plus a deposit into a savings account from Medicare to help pay expenses.

      • Good fit if you want control over how your healthcare dollars are spent.

Medicare Advantage Costs

  • Many plans advertise $0 premiums, and yes, those are real, but you’ll still pay the Part B premium.

  • Copays, deductibles, and coinsurance vary depending on the plan.

  • Every plan has a maximum out-of-pocket limit (unlike Original Medicare), which protects you from catastrophic costs.

Example Cost Scenario

  • $0 HMO Plan:

    • Monthly premium: $0

    • PCP visit: $10 copay

    • Specialist visit: $0 copay

    • Out of pocket maximum: $6,700

  • $40 PPO Plan

    • Monthly premium: $40

    • PCP visit: $0 copay

    • Specialist visit: $20 copay

    • Out of pocket maximum: $5,500

Which is better? Depends on your health, how often you see doctors, and whether you travel or want more provider flexibility.

Who Medicare Advantage Works Best For

  • You want everything in one plan: medical, hospital, drug, and extras.

  • You’re comfortable using a provider network.

  • You prefer predictable copays and an annual out-of-pocket limit.

  • You want extras like dental, vision, or hearing coverage that Original Medicare doesn’t include.

Not always the best fit if

  • You want nationwide freedom to see any doctor that accepts Medicare.

  • You travel often or spend time in multiple states.

  • You prefer Medigap-style “set it and forget it” coverage.

Key Takeaways

  • Medicare Advantage offers more benefits and protection than Original Medicare.

  • Plans differ by carrier and region. The “best” plan for your neighbor, relative, or spouse may not be the best for you.

  • Comparing your options each year during AEP is crucial.

Next Steps.

Not sure if a Medicare Advantage plan is right for you?

Schedule a free consultation with our licensed advisors to review your choices side-by-side with our Medicare Audit™️.

Schedule a consultation

Medicare Advantage FAQs

  • No. When you join a Medicare Advantage plan, you still have Original Medicare, but your coverage is provided by a private insurer approved by Medicare. Original Medicare acts as secondary coverage.

  • Private plans that bundle Part A, B, and usually D, often with extras like dental, vision, and hearing.

  • Most do, but not all. Always check the plan details to confirm.

  • It depends. Advantage plans often have lower premiums but can mean higher out of pocket costs. Supplement plans have higher premiums, but offers predictable costs and nationwide access.

  • They can depending on your home residence. Many use HMO or PPO Networks. That means you’ll usually need to see in-network providers for the best pricing.

  • You can. During Annual Enrollment (October 15 - December 7) or Open Enrollment (January 1 - March 31).