PART C COVERAGE
Medicare Advantage Plans
All-in-one Medicare coverage from top-rated carriers. We compare every plan available in your zip code at no cost to you.
WHAT IS MEDICARE ADVANTAGE?
Everything Medicare Covers —
In One Plan
Medicare Advantage, also called Part C is an alternative way to receive your Medicare benefits. Instead of using Original Medicare (Parts A and B) directly through the federal government, you receive your coverage through a private insurance company that has been approved and regulated by Medicare.
These plans must cover everything that Original Medicare covers, but most go well beyond that; bundling prescription drug coverage (Part D), routine dental, vision, hearing, and even fitness benefits into one convenient monthly premium that is often $0.
How Medicare Advantage Works
When you enroll in a Medicare Advantage plan, Medicare pays the private insurance company a set amount each month to manage your care. The insurance company then provides your benefits. Sometimes these benefits are less than you would pay under Original Medicare, and often with additional benefits included.
You still have Medicare, your red, white, and blue Medicare card stays with you. But the private insurer becomes your primary coverage provider for as long as you're enrolled in the Advantage plan.
Medicare Advantage vs. Original Medicare—Key Differences
⟶ Cost predictability: MA plans have annual out-of-pocket maximums; Original Medicare does not
⟶ Prescription drugs: Most MA plans include Part D; Original Medicare requires a separate plan
⟶ Extra benefits: MA plans often include dental, vision, and hearing; Original Medicare does not
⟶ Networks: MA plans typically require you to use in-network providers; Original Medicare does not
⟶ Referrals: HMO-type MA plans may require referrals; PPO plans generally do not
Types of Medicare Advantage Plans
HMO—Health Maintenance Organization
HMO plans require you to use doctors and hospitals within the plan's network, except in emergencies. You'll typically choose a primary care physician who coordinates your care and provides referrals to specialists. HMO plans generally have the lowest premiums of any Medicare Advantage plan type.
PPO—Preferred Provider Organization
PPO plans give you the flexibility to see any doctor who accepts Medicare in-network or out-of-network without a referral. You'll pay less when using in-network providers, but you're never locked out of a provider entirely. PPO plans offer more flexibility at a somewhat higher premium than HMOs.
PFFS — Private Fee-for-Service
PFFS plans set their own payment terms for providers. Any Medicare-approved provider who accepts the plan's payment terms can treat you. These plans are less common but can work well in rural areas with limited network options.
SNP — Special Needs Plans
SNPs are designed for people with specific diseases or characteristics, including dual-eligible individuals who qualify for both Medicare and Medicaid. These plans tailor their benefits to the specific needs of the populations they serve.
What We Look At When Comparing Plans For You
As an independent agency, we aren't compensated more for recommending one plan over another; which means our only goal is finding the right fit for your specific situation. When we compare plans in your zip code, here's exactly what we evaluate:
⟶ Your doctors: We verify that your current physicians are in-network before recommending any plan
⟶ Your prescriptions: We run your drug list against each plan's formulary to compare your actual drug costs
⟶ Monthly premium: Many plans are $0/month, but premium is only one part of your total cost
⟶ Deductibles and copays: What you pay when you actually use the plan matters more than the premium
⟶ Maximum out-of-pocket: Your worst-case annual cost, this number varies significantly between plans
⟶ Extra benefits: dental, vision, hearing, OTC allowances, and fitness benefits that can have real dollar value
⟶ Star ratings: CMS rates every plan 1–5 stars for quality and performance, we prioritize highly rated plans
Annual Enrollment and Plan Changes
Medicare Advantage plans can change their benefits, premiums, networks, and drug formularies every year. That's why we proactively reach out to every client each fall during the Annual Enrollment Period (October 15–December 7) to review your plan and make sure it's still the right fit.
Important Enrollment Periods
⟶ Initial Enrollment Period: 7-month window around your 65th birthday — when you first become eligible
⟶ Annual Enrollment Period (AEP): Oct 15 – Dec 7 each year — switch plans or return to Original Medicare
⟶ Medicare Advantage Open Enrollment: Jan 1 – Mar 31 — switch MA plans or return to Original Medicare once
⟶ Special Enrollment Periods: Triggered by qualifying life events — moving, losing other coverage, etc
COMMON QUESTIONS
Medicare Advantage FAQ
Is there really a $0 premium Medicare Advantage plan?
Yes, many Medicare Advantage plans in the Dayton area carry a $0 monthly premium. However, you still pay your Medicare Part B premium ($202.90/month in 2026). A $0 plan doesn't mean free it means the plan doesn't charge an additional premium on top of Part B.
Can I keep my current doctors with Medicare Advantage?
Possibly, it depends on the plan. This is the most important question to answer before choosing any plan. We verify your specific physicians against every plan's network before making any recommendation.
What happens if I need care when traveling?
HMO plans cover emergency and urgent care nationwide but routine care requires in-network providers. PPO plans give you more flexibility for out-of-area care. If you travel frequently, a PPO or Medicare Supplement plan may be a better fit.
Can I switch from Medicare Advantage back to Original Medicare?
Yes, during the Annual Enrollment Period (Oct 15–Dec 7) or Medicare Advantage Open Enrollment (Jan 1–Mar 31) each year. However, if you want to add a Medigap plan when switching back, you may face medical underwriting depending on your state and timing.
Do Medicare Advantage plans cover prescription drugs?
Most do, the majority of Medicare Advantage plans include Part D prescription drug coverage. However, formularies (covered drug lists) vary by plan. We always analyze your specific medications against each plan before recommending one.
How much does it cost to use your services?
Nothing, our services are completely free to you. We are compensated by the insurance carriers when we enroll you in a plan, at no additional cost to you. The plan premium is the same whether you enroll through us or directly with the carrier.