MEDICARE ADVANTAGE / PART C
Compare your coverage. Find what fits.
Understand Medicare Advantage plans and what to check before choosing—from doctors and prescriptions to costs and coverage rules.
HICAP offers free, unbiased guidance to help you review your options and make an informed decision.
Free • Confidential • Unbiased
START WITH THE ESSENTIALS
What is Medicare Advantage?
Medicare Advantage, also called Part C, is an alternative to Original Medicare offered through Medicare-approved private insurance companies.
To join, you must have Medicare Part A and Part B and live in the plan’s service area. You remain responsible for the Part B premium, even if assistance or a plan benefit helps pay it.
01 / PROVIDERS
Check your doctors
Confirm that your doctors, specialists, and preferred hospitals participate in the specific plan you are considering.
02 / PRESCRIPTIONS
Review your medicines
Check drug coverage, pharmacy options, and any rules that apply to your prescriptions.
03 / COSTS
Look beyond the premium
Compare what you may pay when receiving care, as well as any monthly plan premium.
UNDERSTAND PLAN TYPES
Different plans have different rules.
Plan availability varies by location. These are some of the options you may encounter.
HMO
Health Maintenance Organization
You generally receive care from providers in the plan’s network and usually choose a primary care doctor. Specialist visits often require a referral.
Exceptions include emergency care, out-of-area urgent care, and temporary out-of-area dialysis. Some HMO Point-of-Service plans allow certain out-of-network services at a higher cost.
PPO
Preferred Provider Organization
You generally pay less when using network providers. Covered services may also be available outside the network, usually at a higher cost.
You generally do not need a referral to see a specialist. Before receiving out-of-network care, confirm coverage and provider participation with the plan.
SNP
Special Needs Plans
SNPs are HMO or PPO plans for people who meet specific eligibility requirements. They include prescription drug coverage and services tailored to the people they serve.
- C-SNP: For people with certain qualifying chronic conditions.
- D-SNP: For people with Medicare and Medicaid, called Medi-Cal in California. Eligibility depends on the plan.
- I-SNP: For people living in certain institutions or who need an institutional level of care.
HICAP can help you understand whether a particular plan may be an option for you.
Other Medicare Advantage options include Private Fee-for-Service (PFFS) and Medical Savings Account (MSA) plans. Ask HICAP about the choices available in your area.
PRESCRIPTION DRUG COVERAGE
Check how Part D fits into your plan.
Most Medicare Advantage HMO and PPO plans include prescription drug coverage. All Special Needs Plans include it.
If you want Medicare drug coverage with an HMO or PPO, choose a plan that includes it. You generally cannot add a separate Part D plan to these plans.
Different rules apply to some other plan types. Check with HICAP before joining a separate drug plan or changing existing coverage.
COMPARE THE FULL PICTURE
What could you pay throughout the year?
Use the plan’s current documents to compare costs for the care and prescriptions you expect to need.
Monthly premiums
Check whether there is a plan premium in addition to your Part B premium.
Deductibles and visits
Review deductibles, copayments, and coinsurance for appointments, hospital stays, and other services.
Prescription costs
Check your medicines, their coverage tiers, and costs at your preferred pharmacies.
Annual spending limit
Review the plan’s out-of-pocket limit for covered Part A and Part B services. Premiums and Part D drug costs are not included in that medical limit.
BEFORE YOU ENROLL
Bring these questions to HICAP.
- Are my doctors and hospitals in this specific plan’s network?
- Are my prescriptions covered, and which pharmacies can I use?
- Will I need referrals or prior authorization for care?
- What coverage would I have when traveling?
- What limits apply to advertised extra benefits?
- How would changing plans affect my existing coverage?
TRUSTED RESOURCES
Explore your options with reliable information.
Compare plan types
Review Medicare.gov’s explanation of Medicare Advantage plan types and their different rules.
Find plans in your area
Use Medicare’s official comparison tool to explore health and drug plans by ZIP Code.
HERE TO HELP
Let’s review your Medicare options.
Speak with a HICAP counselor for free, confidential, and unbiased guidance.