What is Medicare Advantage or Part C?

This is an all-in-one alternative to Original Medicare. These plans are bundled and include coverage for Part A, Part B, usually Part D, and are offered by private insurance companies. These types of plans are managed care, like HMO and PPO plans, which use a network of doctors and hospitals. Medicare Advantage Plans may have lower out-of-pocket costs than original Medicare and typically offer additional benefits such as vision, dental, hearing, or health and wellness programs at no extra cost.

Note: Medicare Advantage Plan (Part C) is NOT the same as Medigap policy (Medicare Supplement). With a Medicare Advantage Plan, you surrender your Medicare benefits to a private insurer. That insurer directs Medicare to pay a monthly capitation to manage your healthcare, plus they assume all the risk. In a Medigap policy, Medicare remains the primary payer while the Medigap policy is the secondary payer. To learn more about how Medicare Supplement (Medigap) works visit Medicare Supplement (Medi-gap).

Federal regulations require that all coverage plans offered by Medicare Advantage (Part C) be equal to or greater than that offered by Original Medicare. Because Medicare Advantage Plans receive a monthly payment from the federal government to manage your healthcare, they’re able to offer you lower cost healthcare, along with additional services not covered by Original Medicare. Think of it like this: Medicare now pays part or all of your premium for you to be in a Medicare Advantage Plan, rather than being the payer when you need to use your insurance. The Medicare Advantage Plan you choose will now be the payer when you use your insurance, not Medicare.  

How Much Does Medicare Part C Cost?

There are many Medicare Advantage Plans and they vary in cost and benefits, depending where you live. To find out what plans are available in your area, please consult with an AHIC agent today. Contact here

Medicare Advantage (Part C) Plans assume all the financial risk when it comes to hospital and medical expenses. Although you’re no longer responsible for the deductibles associated with Original Medicare and the 20% coinsurance, it doesn’t mean you have no financial responsibility. You may be responsible for monthly plan premiums, deductibles, and copays for services. 

Example: You could conceivably pay $0 in monthly premiums, a $0 copay for a primary or specialist physician visit, $90 for an ER visit, a $40 copay for an MRI, and a 20% chemotherapy copay. 

Many Medicare Advantage (Part C) Plans often include a built-in Part D drug plan. This means you’ll have all your medical and drug expenses covered by just one plan. Pay close attention to the drug formulary, or drug list, that has been approved by the plan. Medicare Advantage Plans set their own price tiers for certain drugs and only cover certain name brand drugs listed on their formulary. Checking all of your prescriptions against each plan is highly recommended as cost can vary greatly between companies. Be sure to consult with your AHIC agent and check all your medications before making a choice. 

Medicare Advantage Plans are also required to have an out-of-pocket maximum (M.O.O.P.) on your medical spending. This is your financial safety net. If you have heavy health spending that results in a certain out-of-pocket limit, the plan kicks in and pays the rest for the remainder of the calendar year. The Medicare stated M.O.O.P. is $6700 for each calendar year, but can often be less depending on your plan.

How do I get Medicare Part C?

In order to qualify for a Medicare Advantage Plan, you must be enrolled in Medicare Part A and Part B, live in the service area of the plan, and not have end-stage renal disease (there are special needs plans in some areas for people diagnosed with ESRD). 

Consult with an AHIC agent today to find the plans are available in your area here

A Clear Line Of Sight With A Medicare Part C Plan

First, let’s look at Original Medicare Part A and Part B. With Original Medicare, you’re able to receive care from any doctor in the United States who accepts Original Medicare without the need of a referral or authorization. Most of the time, this is ideal. But, you’ll have to keep track of the communication between your medical providers. This raises questions: how do you find a good doctor, specialist, or hospital and keep track of the care you have received while making sure all your doctors know the medications you’re taking? Keeping track of your healthcare can be more complex than you think. 


If you currently see multiple doctors, like a cardiologist, orthopedic surgeon, oncologist, podiatrist, and a primary doctor, that’s 5 doctors and 25 lines of communication total (5 doctors x 5 lines of communication = 25 lines). This can be difficult to keep track of and become much harder as you get older.

With a Medicare Advantage Plan, there is a clear line of sight between you, your health plan, and all of your doctors. Generally, you will be part of a local network or medical group and you’ll need to visit doctors and facilities within that network. 

The costs associated with Original Medicare Part A and Part B can be high. The Part A deductible of $1408 must be met, Part B has a $198 deductible, and you’ll have a 20% copay with no limit for medical services after you’ve met your deductible. 

By joining a Medicare Advantage Plan you eliminate the high out-of-pocket associated with Original Medicare.

We’re on Your Side

Still have questions or need assistance applying for your Medicare benefits? You’re not alone. AHIC is here to walk you through the process of applying for Medicare or shopping for the plan that’s right for you. Our services are free for you and we’ll be here to help for the lifetime of your policy.

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