Medicare Advantage Plans (Medicare Part C) Explained
Medicare Part C is not a separate benefit on its own. Rather, Part C is the part of Medicare law that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans — such as HMOs and PPOs — contract with the federal government and are known as Medicare Advantage Plans.
If you’re wondering what is Medicare Advantage, this guide explains how it works, what it covers, and how it differs from receiving coverage through Original Medicare.
How Medicare Advantage Works
If you choose to, you can get your Medicare coverage through a Medicare Advantage Part C plan instead of through Original Medicare. Here’s what that means:
- Medicare Advantage Plans must offer, at minimum, the same benefits as Original Medicare (the benefits covered under Parts A and B).
- Plans can apply different rules, costs, and coverage restrictions than Original Medicare.
- You typically get Part D prescription drug coverage bundled into your plan, known as MAPD (Medicare Advantage Prescription Drug) coverage.
- You may pay a monthly premium for your Medicare Advantage coverage, in addition to your standard Part B premium.
Medicare Advantage Coverage and Benefits
Medicare Advantage benefits are structured to meet or exceed what Original Medicare provides, but the way that coverage is delivered can vary significantly by plan. Many different kinds of Medicare Advantage Plans are available, giving beneficiaries options based on their coverage needs and budget.
Types of Medicare Advantage Plans
Medicare Advantage Plans come in several common formats:
- Medicare Advantage HMO (Health Maintenance Organization) — Typically requires you to use a network of doctors and hospitals, often with a primary care physician coordinating your care.
- Medicare Advantage PPO (Preferred Provider Organization) — Generally offers more flexibility to see providers outside the plan’s network, often at a higher cost.
- Medicare Advantage PFFS (Private Fee-for-Service) — Determines how much it pays providers and how much you owe when you get care, with rules that can vary by plan.
Because rules, costs, and covered services differ between these plan types, it’s worth comparing your options carefully — including plan availability where you live, such as here in Fort Myers and across Southwest Florida.
Using Your Medicare Advantage Plan Card
If you join a Medicare Advantage Plan — whether an HMO, PPO, or PFFS — you will not use the red, white, and blue Original Medicare card when you visit the doctor or hospital. Instead:
- You’ll use the membership card your private plan sends you to access covered health services.
- If your plan includes Medicare prescription drug coverage (Part D), you’ll also use this same card at the pharmacy.
Frequently Asked Questions
What is Medicare Advantage?
Medicare Advantage, or Part C, is the part of Medicare law that allows private insurance companies to provide Medicare benefits through plans like HMOs, PPOs, and PFFS, which contract with the federal government.
How does Medicare Advantage work?
Medicare Advantage Plans provide at least the same coverage as Original Medicare Parts A and B, but with different rules, costs, and restrictions, and often include Part D prescription drug coverage as well.
What is the difference between Medicare Advantage HMO and PPO plans?
An HMO plan typically requires you to use a network of providers and often a primary care physician, while a PPO plan generally allows more flexibility to see out-of-network providers, usually at a higher cost.
What is a Medicare Advantage PFFS plan?
A PFFS (Private Fee-for-Service) plan determines how much it pays providers and how much you owe for care, with specific rules that vary by plan.
Do Medicare Advantage plans include prescription drug coverage?
Many Medicare Advantage plans include Part D coverage as part of the plan, known as MAPD, though this varies by specific plan.
What card do I use with a Medicare Advantage plan?
You’ll use the membership card provided by your private Medicare Advantage plan, rather than the red, white, and blue Original Medicare card, for both medical services and pharmacy visits if your plan includes drug coverage.
Do I still pay a Part B premium with Medicare Advantage?
Yes. In addition to any premium your Medicare Advantage plan charges, you’re still responsible for your standard Part B premium.
The content is developed from sources believed to be providing accurate information. The information in this material is not intended as tax or legal advice. It may not be used for the purpose of avoiding any federal tax penalties. Please consult a legal or tax professional for specific information regarding your individual situation. The opinions expressed and material provided are for general information and should not be considered a solicitation for the purchase or sale of any security.
