Medicare Advantage
Medicare Advantage (also known as Part C) is a voluntary “all in one” alternative to original Medicare. It has “bundled” plans that include Part A, Part B, and usually Part D, and is offered by private insurance companies. Advantage plans give you at least the same coverage as Original Medicare. Medicare Advantage Plans can include extra benefits including routine vision exams and hardware, routine hearing exams and hearing aids, fitness programs, and OTC benefits.
Decide if you want Original Medicare or a Medicare Advantage Plan (like an HMO or PPO)
When you first enroll in Medicare and during certain times of the year, including the Annual Enrollment Period from October 15 to December 7, you can choose how you get your Medicare coverage. There are two main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C).
If you choose Original Medicare, you can decide if you want Medicare Supplement Insurance (Medigap) and Medicare Prescription Drug coverage. With Original Medicare alone, you will have deductibles and a 20% coinsurance on Part B. You can visit any doctor or hospital that participates in Medicare, and most do.
If you choose a Medicare Advantage Plan, this usually includes prescription drug coverage, but may not.
Here are some things to know:
What’s Medicare Advantage?
Sometimes called “Part C” – includes both Part A (Hospital Insurance) and Part B (Outpatient Services). To be eligible you must reside in the plan’s service area and have Medicare Parts A & B.
Who provides coverage?
Private insurance companies approved by Medicare.
How do you choose your providers?
You may need to use health care providers who participate in the plan’s network.
How much does it cost?
- In 2025, the standard Part B premium amount is $185.00 (or higher depending on your income).
- You usually pay a monthly premium for your Medicare Advantage Plan (in addition to your monthly Part B premium). Some may be at no premium in your area.
- Instead of with Original Medicare where you pay deductibles and 20% on Part B, with a Medicare Advantage plan you may pay a co-payment or co-insurance for covered services. Primary Care visit co-pays could be as little as $0 and specialist visit co-pays $35. For a hospitalization you may pay as little as $325 per day for 4 to 7 days depending on the plan. Any days over that are at no cost. Other co-pays or coinsurance may be: X-Rays- $16, Lab tests- $20, Out-patient Surgery-$200 to $350 or up to 20%, an MRI could be as little as $200 or a maximum of $400. All varying by plan.
- Plans have a yearly limit on your out-of-pocket costs. Once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. Every Medicare Part C plan must have an out-of-pocket (OOP) maximum to protect you. Medicare sets the highest allowable amount for this OOP maximum each year. This amount is $9,350 in-network or $14,000 for in-network and out-of-network services combined for 2025. This means that the most you will spend on that plan for Part A and B services is $9,350 for 2025 (Part D spending is separate). Many plans set a lower OOP maximum. Remember, if you have just Original Medicare with no other coverage you have no out-of-pocket limit on Part B outpatient services.
- Your out-of-pocket costs may be lower in an Medicare Advantage plan. This option may be more cost effective for you.
- Many Medicare Advantage plans offer vision, hearing, dental coverage, fitness programs, and OTC benefits. Costs, extra coverage, and rules vary by plan.
Call Progressive Concepts Insurance for a free consultation and quote your Medicare Advantage plan today