Medicare Advantage (Part C)
All-in-one Medicare coverage from a private plan — often with extras built in
Overview
Medicare Advantage plans (Part C) are HMO, PPO, or specialty plans offered by private insurance carriers approved by Medicare. Enrolling in a Medicare Advantage plan means you get most of your Part A & Part B coverage through the plan instead of Original Medicare, & most plans also bundle Part D prescription drug coverage.
What Medicare Advantage is
Medicare Advantage (also called Part C) is an alternative way to receive your Medicare benefits. Instead of getting Part A & Part B directly from the federal government, you enroll in a private plan approved by Medicare & get all of that coverage — & usually much more — through a single carrier.
Most Medicare Advantage plans are HMOs or PPOs, & the majority bundle prescription drug coverage (Part D) into the same plan. These combined plans are known as MAPD.
What it covers
Every Medicare Advantage plan must provide at least the same coverage as Original Medicare, including:
- Primary care & specialist visits
- Hospital, emergency, & urgent care
- Imaging & lab services
- Prescription drugs on most plans (MAPD)
Extra benefits many plans include
Depending on the plan & your county, Medicare Advantage may also add benefits Original Medicare doesn't cover:
- Dental, vision, & hearing coverage
- Rehabilitation & gym or fitness memberships
- Transportation to medical appointments
- Food, grocery, or OTC allowances
- Meals after a hospital stay & utility-card benefits
- Medical alert devices
- Part B premium give-back
Extras aren't guaranteed on every plan
Benefits like dental, vision, hearing, transportation, food card, OTC allowance, & give-back are optional add-ons — availability & value change by plan & county each year.
Who is eligible
- Must already be enrolled in both Medicare Part A & Part B
- Must live in the plan's service area
- Available whether you're new to Medicare or switching from Original Medicare
Why someone chooses Medicare Advantage
Medicare Advantage appeals to beneficiaries who want simplicity — one plan, one ID card, one carrier — & value the extra benefits that Original Medicare doesn't provide. Many Florida plans have a $0 monthly premium beyond your Part B premium, & every plan includes an annual out-of-pocket maximum that caps your medical spending.
Important benefits & limitations
- You still pay the standard Part B premium ($202.90 in 2026)
- HMO plans typically require you to use in-network providers & get referrals for specialists
- PPO plans let you go out of network for higher cost sharing & don't require referrals
- Special Needs Plans (SNPs) tailor benefits & drug lists to specific conditions or Medicaid dual-eligibles
- You cannot use or be sold a Medigap policy while enrolled in a Medicare Advantage plan
HMO vs. PPO vs. specialty plans
HMO members typically need referrals for specialists & must use in-network providers except for urgent, emergency, or authorized care. HMO-POS plans allow limited out-of-network use for higher cost sharing. PPOs let you see in- or out-of-network providers (higher cost out of network) with no referrals. MSA plans deposit funds into a savings account you use for Medicare-covered expenses.
Key highlights
- Bundles Part A + Part B, & usually Part D, into one plan
- You still pay the standard Part B premium ($202.90 in 2026)
- Many $0-premium plans are available in Florida
- Annual out-of-pocket maximum caps your medical spending
- Uses HMO or PPO networks — most include drug coverage (MAPD)
- You cannot use or be sold a Medigap policy while enrolled in Medicare Advantage
What it covers
Hospital care (Part A)
Inpatient stays, skilled nursing, & hospice — coordinated by the plan.
Medical services (Part B)
Primary care, specialists, outpatient care, emergency & urgent care, imaging & labs.
Prescription drugs (Part D)
Included in most Medicare Advantage plans (MAPD).
Extra benefits (varies by plan)
Dental, vision, hearing, rehabilitation, gym memberships, transportation, food & OTC allowances, meals, utility card, medical alert device, fitness benefit, & Part B give-back.
HMO vs. PPO vs. specialty plans
HMO members typically need referrals for specialists & must use in-network providers except for urgent, emergency, or authorized out-of-network care. HMO-POS plans allow limited out-of-network use for higher cost sharing. PPOs let you see in- or out-of-network providers (higher cost out of network) with no referrals. Special Needs Plans (SNPs) tailor benefits & drug lists to specific conditions or Medicaid dual-eligibles. MSA plans deposit funds into a savings account you use for Medicare-covered expenses.
Extras aren't guaranteed on every plan
Benefits like dental, vision, hearing, transportation, food card, OTC allowance, & give-back are optional add-ons — availability & value change by plan & county each year.
Frequently asked questions
Can I switch plans each year?+
Yes — during Medicare's Annual Enrollment Period (October 15 – December 7) you can change Medicare Advantage plans for the following year. There is also a Medicare Advantage Open Enrollment Period each January 1 – March 31.
Do I still pay my Part B premium?+
Yes. You keep paying your Part B premium ($202.90 in 2026) in addition to any Medicare Advantage plan premium (which is often $0).
Can I keep a Medigap policy?+
No. If you join a Medicare Advantage plan, you can't use or be sold a Medicare Supplement Insurance (Medigap) policy.
Do I need referrals?+
It depends on the plan. HMOs typically require them; PPOs & PFFS plans usually don't.
Explore other Medicare options
Jump directly to any other Medicare plan type — no need to head back to the homepage.
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Physician services, outpatient care, tests, & supplies — per calendar year
Predictable costs with the freedom to see any Medicare doctor
Standalone drug coverage tailored to the medications you take
Affordable coverage for cleanings, fillings, & major dental care
Affordable coverage for eye exams, glasses, contacts, & more
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