Part C – Advantage Plans

Advantage plans are private Medicare plans offered by insurance companies that have a contract with Medicare. You receive your Medicare benefits directly through the insurance plan, generally including prescription drug coverage. These plans must cover all Medicare benefits, but the insurance company administers the plan and costs are set by the plan as per the Summary of Benefits. Unlike Original Medicare, these plans offer you an Annual Out-of-Pocket cap on your costs for your financial protection. These plans can be PFFS, PPO, HMO/POS & HMO.

Part C – Advantage Plans and Your Doctor

Before joining a plan be sure to verify that your doctors are covered in-network, as these plans are network driven. HMO plans require you to always use in-network providers. HMO/POS plans allow you to see some providers out-of-network usually at a higher cost. PPO plans allow you to see any providers out-of-network usually at a higher cost. PFFS plans allow you to see any provider that accepts Medicare beneficiaries and agrees to the plans’ terms & conditions. All plans cover any provider in an emergency.

Part C – Advantage Plans Popularity

These plans have gained in popularity since the early 2000’s because many plans are offered at $0 monthly premium (you must continue to pay your Part B monthly premium to Medicare), you only pay for the services you receive, and the plan provides an annual cap on your expenses.

Generally speaking, you agree to keep your plan for the balance of the calendar year in which you enroll, and must enroll during valid election period, such as turning 65, losing a Group Health plan, or during the Annual Election Period where you can add, drop or change coverage. Restrictions may apply.

Advantage plans may also cover benefits you don’t normally get through Original Medicare. These may include: dental, routine vision exams, glasses, routine hearing exams, hearing aids, gym memberships, OTC allowances, nursing hotlines, routine medical transportation and more.

I am a general insurance agent offering Medicare insurance plans. I can meet you in our office, in your home or you may attend one of our educational or sales meetings. I provide personal attention, consider all your individual needs and tailor a plan to fit your personal needs. I do not charge a consultation fee as we are compensated directly from the insurance companies. As an added bonus you have me as your local agent available to answer your questions year-round! Would you like to further explore your Medicare insurance options?

Email me at or for the fastest response call (603) 767-6673.