Medicare
Medicare Advantage (Part C)
Network plans from private carriers that bundle Parts A and B, usually Part D, and often dental, vision and hearing.
$0 advisor fee on this line, including every review afterwards
A Medicare Advantage plan is a private plan that takes over the administration of your Medicare benefits. You stay in Medicare, you keep paying your Part B premium, and the plan becomes the one card you hand over at the front desk. Most plans in Pinellas County fold prescription drug cover in, and most add routine dental, vision, hearing and an over-the-counter allowance on top.
The trade-off is structural, not cosmetic. Advantage plans work through a network. HMO plans generally require you to stay inside it and to use a primary care physician as the gatekeeper for specialist referrals. PPO plans let you go out of network at a higher cost share. In exchange you get an annual out-of-pocket maximum, which Original Medicare on its own does not have, and a premium that is often low or zero beyond Part B.
We check three things before we recommend any Advantage plan: whether your doctors are contracted for next year, whether your prescriptions sit on the plan's formulary at a tier you can live with, and how much you travel. Those three answers decide more than the premium does.
What this covers
- Everything Part A and Part B cover. By law an Advantage plan must cover everything Original Medicare covers, except hospice, which stays with Original Medicare.
- An annual out-of-pocket maximum. Once you hit the plan's in-network maximum, the plan pays 100% of covered Part A and B services for the rest of the year. Original Medicare alone has no ceiling.
- Part D drugs in most plans. MA-PD plans carry the drug benefit inside the plan. If you enrol in a standalone Part D plan while on most MA plans, you will be disenrolled from the MA plan.
- Extras that vary a lot by plan. Routine dental, vision and hearing allowances, fitness memberships, transport to appointments, over-the-counter cards. These are not standardised, so the same carrier's two plans can differ sharply.
- A single card and a single appeal path. One member services number, one formulary, one provider directory. For people managing several conditions this alone is worth a lot.
How we work it with you
- List the doctors you will not change. We check each one against next year's contracted provider file, not this year's. Networks are re-negotiated annually and a January surprise is the most common complaint we hear.
- List every prescription with dose and frequency. We run them through each plan's formulary to find the tier, the quantity limit, and whether prior authorisation or step therapy applies.
- Set your travel pattern. Months away, a second home, regular trips to see family out of state. This decides HMO, PPO, or an Advantage plan being the wrong structure entirely.
- Compare three plans side by side. Premium, deductible, primary and specialist copays, inpatient per-day cost share, drug tiers and the out-of-pocket maximum. Not a brochure.
- Enrol and diarise the review. We complete the enrolment with you, confirm the effective date, and put the next Annual Enrollment Period in the calendar. Plans change every year; a plan that fits now may not in two years.
Who this usually fits
- You use local providers and have no plans to move
- You want dental, vision and hearing cover without buying a separate policy
- You want a cap on what a bad year can cost you
- You are comfortable with referrals and prior authorisation as the price of a lower premium
When we would point you elsewhere
If you split the year between two states, see specialists at out-of-state centres, or want to change doctors without checking a network first, look hard at a Medicare Supplement instead.
What drives the cost
Typical ranges for this area. Your own price depends on your address, your age and the plan you pick.
| Factor | Typical range or shape | Why it matters |
|---|---|---|
| Plan premium | $0 - $95 / month | Separate from and in addition to your Part B premium, which you keep paying. |
| In-network out-of-pocket maximum | $3,500 - $8,850 | Set by the plan within the federal limit. Lower maximums usually mean higher copays. |
| Primary care visit | $0 - $20 | Specialist copays are typically higher and may need a referral on an HMO. |
| Inpatient hospital | Per-day copay for the first 5 to 7 days | This is where two plans with identical premiums diverge most. |
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Carriers we can quote on this line
Availability is set county by county, sometimes by zip code.
- Kestrel Health Plans
- Northwind Care
- Cypress Ridge Health
- Sandpiper Senior Plans
- Anchorline Plans
- Tidewater Assurance
Questions we are asked about medicare advantage (part c)
No. You stay enrolled in Medicare and keep paying your Part B premium. The private plan administers your benefits under contract with Medicare.
You can change during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period. The catch is the supplement: outside your one-time Medigap open-enrolment window, a supplement carrier can medically underwrite you and decline. We explain that before you enrol, not after.
Networks are re-contracted annually. We check the following year's provider file during the Annual Enrollment Period and tell you if a plan is losing a group you use.
They vary enormously. Some plans cap dental at a few hundred dollars a year for cleanings only; others include a meaningful allowance for major work. We show the actual benefit table, not the advert.
Related coverage
Medicare Supplement (Medigap)
Standardised policies that pay the deductibles and coinsurance Original Medicare leaves behind, with no network at all.
Compare coverage
Part D prescription drug cover
Standalone drug plans, formulary tiers, the coverage stages, and the penalty for waiting.
Compare coverage
Dental, vision and hearing
Standalone cover for the three things Original Medicare does not pay for at all.
Compare coverage
Call and ask us anything. Nothing is sold on the phone.
Twenty minutes with someone who will ask for your doctor list before naming a plan. If the right answer is the plan you already have, that is what you will hear.
(727) 555-0241Mon - Thu 8:30 am - 5:30 pm · Friday 8:30 am - 3:00 pm · TTY 711 · Se habla español
No cost to you, ever. We are compensated by carriers, not by the people we advise.