What Is Part C?
Medicare Advantage also known as Medicare Part C is an alternative way to receive your Medicare benefits. Instead of getting your Medicare coverage through the federal government (Original Medicare), you get it through a private insurance company that is approved and contracted by Medicare.
You enroll in a Medicare Advantage plan through a private insurance company. That plan becomes your primary insurer instead of the federal Medicare program. The insurance company provides you with a network of doctors, specialists, hospitals, and possibly pharmacies to use.
Monthly premium: Most plans cost $0/month (though you must still pay your Part B premium, which is usually taken from your Social Security check)
Copays/coinsurance: Pay-per-service (e.g., $10 to see your PCP, $40 to see a specialist)
Out-of-pocket maximum: Once you hit this limit, the plan pays 100% of covered costs for the rest of the year
What is Part C?
How Does It Work?
What Will It Cost?
Pro's & Con's of Part C
Pro's
Con's
All-in-one coverage (medical, hospital, and often prescription + dental/vision)
Lower or $0 monthly premiums
Extra benefits not covered by Original Medicare
Annual out-of-pocket maximum for medical expenses
Coordinated care through provider networks
Provider networks may be limited to your local area
Referrals may be required
You may need prior authorizations for certain services
Plan rules and benefits can change every year
Out-of-network care can be expensive or not covered, depending on the plan type
What is Medicare Part C?
Medicare Advantage (Continued)
Medicare Advantage (Part C) plans are offered by private insurance companies that are approved by Medicare
These plans combine the coverage of Medicare Part A and Part B into a single plan and are required to provide at least the same level of coverage as Original Medicare
Most Medicare Advantage plans also include additional benefits that Original Medicare typically does not cover
These often include:
Dental services
Vision care
Hearing exams and hearing aids
Prescription drug coverage
Fitness programs
Transportation or wellness benefits
Many Medicare Advantage plans are available with $0 monthly premiums although members must still continue paying their Part B premium
Costs such as co-pays and coinsurance vary depending on the specific plan
It is also important to understand that Medicare Advantage plans vary by county, meaning the plans available in one area may be different from those offered in another
Chronic Special Needs Plans (C-SNPs)
Certain Medicare Advantage plans are specifically designed for individuals with chronic health conditions
These are known as Chronic Condition Special Needs Plans
These plans are built to better manage specific health conditions and often offer:
Lower copays for condition-related care
Coordinated care programs
Additional benefits tailored to those health needs
Most plans offer an allocated allowance for healthy foods.
Qualifying conditions may include things such as diabetes, cardiovascular disorders, kidney disorders or chronic heart conditions
Medicaid and How It Differs From Medicare
While Medicare is a federal health insurance program
Medicaid is a state and federally funded program designed to assist individuals with limited income and financial resources
Medicaid programs vary by state, meaning eligibility rules and benefits can differ depending on where a person lives
People may qualify for Medicaid based on factors such as:
Income level
Household size
Disability status
Long-term care needs
Some individuals qualify for both Medicare and Medicaid
These individuals are commonly referred to as dual eligible
Medicare & Medicaid Together
When someone has both Medicare and Medicaid they may receive significant additional support with healthcare costs
Medicaid can help cover expenses such as:
Medicare premiums
Deductibles
Copayments
Certain long-term care services
Individuals who qualify for both programs may also be eligible for special Medicare Advantage plans designed specifically for dual eligible beneficiaries
These plans often include additional benefits such as:
Enhanced dental coverage
Over-the-counter benefit allowances
Food or utility assistance programs (depending on plan availability)
Transportation services
Care coordination services
Because Medicaid eligibility and benefits vary by state, the exact coverage and assistance available can differ from one location to another
Types of Medicare Advantage Plan Networks
HMO (Health Maintenance Organization)
What it means
An HMO plan requires members to use a specific network of doctors and hospitals. Care must be coordinated through a Primary Care Physician (PCP), and referrals are needed to see most specialists
Key features
PCP required
Referrals needed for specialists
No coverage outside the network (except in emergencies or urgent care)
Usually has lower monthly premiums and out-of-pocket costs
PPO (Preferred Provider Organization)
What it means
A PPO plan offers more flexibility in choosing healthcare providers. Members can see any doctor or specialist, but they’ll pay less when staying in-network
Key features
No PCP required
No referrals needed for specialists
Out-of-network coverage available, but more expensive
Usually higher premiums than HMO plans
Who it's best for:
People who want freedom to choose doctors without referrals, even if it means paying more.
POS (Point of Service)
What it means
A POS plan combines elements of HMO and PPO. You choose a PCP and need referrals for specialists, but you have limited out-of-network coverage if you're willing to pay more
Key features
PCP required
Referrals needed
Out-of-network care is partially covered, but higher cost
Balances cost savings of HMO with flexibility of PPO
PFFS (Private Fee-for-Service)
What it means
A PFFS plan lets members see any Medicare-approved provider who agrees to accept the plan’s payment terms. No network restrictions, but providers must accept the plan on a case-by-case basis
Key features
No network — freedom to choose providers
No PCP or referrals required
Doctors/hospitals can refuse to accept the plan, even if they previously accepted it
Costs and coverage can vary widely
Our Mission
At Argos Insurance Solutions, our mission is to provide clear guidance, dependable service, and lasting support to every client we serve. We believe that choosing health and life insurance coverage should never feel confusing or overwhelming, which is why we are committed to explaining plan options with patience, clarity, and honesty.
We recognize that healthcare needs, medications, and plan benefits can change from year to year. By staying informed about industry updates and conducting thoughtful annual reviews, we help ensure that each client’s coverage continues to align with their needs while identifying opportunities for improved benefits or cost savings whenever possible.