Medicare Advantage Plans
Understanding Medicare Advantage
Medicare Advantage, sometimes called Part C, is an alternative way to receive your Medicare benefits. Instead of using Original Medicare with a Supplement, you can enroll in a private plan that combines hospital, doctor, and often prescription drug coverage into a single policy.
Medicare Advantage plans are offered by major insurance companies you may already know. They can provide benefits similar to the health insurance you had while working, but with differences that make them a strong option for many retirees.
How Medicare Advantage Works
With a Medicare Advantage plan, your Medicare benefits are administered through a private insurer. These plans may include:
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Hospital coverage (Part A) and doctor/outpatient coverage (Part B)
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Prescription drug coverage (Part D) in many plans
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Optional extras such as vision, dental, hearing, or wellness programs
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Potentially lower out-of-pocket costs for certain services
Unlike Medicare Supplement plans, which only fill the gaps in Original Medicare, Medicare Advantage plans replace Original Medicare entirely. You still have Medicare, but the private plan manages your coverage.
Types of Medicare Advantage Plans
Medicare Advantage plans can take several forms, including:
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PPO (Preferred Provider Organization): Offers flexibility to see out-of-network providers, usually at a higher cost
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HMO (Health Maintenance Organization) / MCO (Managed Care Organization): Requires using a network of providers and may require referrals for specialists
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Fee-for-Service: Similar to traditional insurance, but managed by the insurance company rather than the government
Each plan differs in costs, benefits, and provider networks, making it important to review each option carefully.
Advantages of Medicare Advantage
Medicare Advantage can be a strong alternative to a Supplement plan for many people because it:
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Combines multiple benefits — hospital, doctor, and prescription coverage — into a single plan
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May offer extra benefits like vision, dental, hearing, or wellness programs
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Often has lower monthly premiums than a Medicare Supplement plan combined with a Part D plan
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Provides an annual out-of-pocket maximum, limiting total healthcare expenses
Things to Consider
When choosing a Medicare Advantage plan, keep these points in mind:
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Provider Networks: Many plans require you to use network doctors and hospitals. Make sure your preferred providers are included.
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Prescription Coverage: Each plan’s formulary (drug list) varies. Confirm that your medications are covered.
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Cost Structure: Check premiums, co-pays, deductibles, and out-of-pocket maximums.
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Flexibility: Some plans may require referrals to see specialists or have geographic restrictions.
How to Decide Between Medicare Advantage and a Supplement
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Medicare Advantage may be ideal if you want an all-in-one plan with extra benefits and predictable out-of-pocket costs.
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Medicare Supplement (Gap Insurance) may be better if you want maximum freedom to choose any provider who accepts Medicare and prefer predictable cost coverage for gaps like co-pays and deductibles.
Professional Benefit Solutions works with you to compare both options, ensuring your plan meets your health needs, covers your medications, and provides peace of mind in retirement.
Our Customers
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“Professional Benefit Solutions helped me with my Medicare Advantage plan and has always taken the extra steps to make sure I knew exactly what I was applying for. They explained the difference between a supplement and an advantage plan and offered me a plan that best suited my needs. They are professional and are always available when I have a question or need help with my insurance questions. I would recommend them to anyone who is turning 65 or who just needs insurance explained to them.”
– Mary, Advantage Plan Client
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