Medicare Advantage (Part C).
Medicare Advantage — also called Part C — is a way to get your Medicare benefits through a private plan that contracts with Medicare. Instead of using Original Medicare directly, you receive Part A and Part B benefits through the plan, usually with Part D drug coverage built in.
How Medicare Advantage plans are structured
Medicare Advantage plans typically use one of these network structures:
- HMO (Health Maintenance Organization). You use the plan’s network of providers and need a primary care physician referral for specialists. Generally lowest premium.
- PPO (Preferred Provider Organization). You can use any provider that accepts the plan, with lower cost-sharing in-network. No referrals required.
- HMO-POS (Point of Service). Like an HMO, but with limited out-of-network options.
- PFFS (Private Fee-for-Service). Less common; you can see any Medicare-approved provider that accepts the plan’s payment terms.
- Special Needs Plan (SNP). Limited to specific groups — see C-SNP and D-SNP.
What Medicare Advantage plans typically include
- All Part A and Part B services
- Most plans include Part D prescription drug coverage
- Many plans include extra benefits — dental, vision, hearing, fitness, transportation — depending on plan and service area
Trade-offs versus Original Medicare
Medicare Advantage typically has lower monthly premiums than Original Medicare + Medigap + Part D, but uses network restrictions and can require prior authorization for some services. Whether that trade-off is worth it depends on your providers, your prescriptions, and how much you travel. See Medigap vs. Medicare Advantage for the full comparison.
How a licensed agent helps
A licensed El-Mag agent compares Medicare Advantage plans against Original Medicare + Medigap based on your specific doctors, prescriptions, and travel patterns.
Compare your Medicare options.