Office Hours
By Appointment
Our Location
617 Cherokee Ct, Davenport IA 52804
Call Us Now
(866) 440-1885
Still have questions?
Get in touch with us
Medicare Part C (Medicare Advantage)
|
|
|
|
|
|
Important Points
Medicare Part C (also known as Medicare Advantage) is an alternative way to receive your Medicare benefits which can also include bundled-in drug coverage.
You can only apply for a Medicare Advantage plan during an available election period.
Most Part C plans have low or no premiums and maximum out-of-pocket limits.
Medicare Part C is not a program that you enroll in through Social Security. It is the official name for the program we know as Medicare Advantage. Medicare Advantage plans cover all of your Part A and Part B benefits plus more and it is administered by private health insurance companies. If you enroll in a Medicare Advantage plan, you receive your Medicare benefits through a private carrier instead of the federal government. There are many additional benefits to enrolling in a Medicare Advantage plan.
Mohring Insurance Services LLC | Talk to a Medicare Expert at (866) 440-1885
What is Medicare Part C?
Medicare Part C plans are optional and they are an alternative way to get your benefits. Also known as Medicare Advantage, Part C plans are provided by private insurance carriers in lieu of the federal government.
It's best to think of Medicare Advantage as a tool that packages everything together in one plan. It will cover your Part A, Part B, and usually Part D all together in a single plan. You will have one ID card you use at the doctors, hospital, and pharmacy. It is similar in a lot of ways to the group health insurance you were used to before turning 65. Most Medicare Advantage plans include a built-in Part D drug plan, although, in some areas, you can find plans without Part D if you don't feel like you need it.
Medicare Advantage plans are much like the group insurance benefits you may have had through your former employer. Typically, there's a local network of providers that you will use. You'll have copays for many services such as doctor's visits, lab tests, ambulance rides, urgent care, hospital stays, outpatient surgeries, and more.
What does Medicare Advantage cost?
Some Medicare Advantage plans have a monthly premium, but many plans have premiums as low as $0 per month. However, this does not mean that Medicare Advantage is free. In order to have a Medicare Advantage plan you must continue to pay your Part B premium. Medicare uses this money to pay for your Medicare Advantage plan. When you enroll in a Medicare Advantage plan, Medicare pays a fixed monthly sum to the insurance carrier to provide your care. The MA company will offer you a monthly premium as low as possible to attract you to their plan.
Medicare Part C (Medicare Advantage) plans have lower premiums than Medigap plans. This is due to the fact that you are agreeing to have your care delivered in the plan's network and pay copays as you go.
The network may be an HMO, which would require you to choose a primary care physician and get referrals for specialist care. There are also Medicare PPOs and Medicare PFFS options, which have some out-of-network benefits. Aside from your monthly premium (if you have one), your spending may include deductibles, copays, and coinsurance up to the plan's out-of-pocket maximum.
The premiums, benefits, copays, and drug formularies can and do change from year to year. This is due to the fact that Medicare Advantage plans must renew their contract with Medicare annually.
Medicare Advantage Out-of-Pocket Maximums
Every Medicare Advantage plan must have an out-of-pocket maximum to protect you and Medicare sets the highest allowable amount for this each year. Currently, in 2025, the out-of-pocket maximum is set at $8,850. What this means is that the MOST you will spend on that plan for your Part A and Part B services is $8,850 (Part D spending is separate). There are many plans that offer much lower out-of-pocket maximums as a way to attract you to their plan. The lower the out-of-pocket maximum is, the more protected you will be in the event that you have a bad year with your health.
A lot of people ask us to compare Original Medicare vs. Medicare Advantage plans. Original Medicare does not have any out-of-pocket maximums to protect you. You could end up paying the 20% Part B coinsurance forever. In the event of a major surgery or long hospitalization that could leave you owing tens of thousands of dollars. So, if you cannot afford the more comprehensive Medigap plans, then a Medicare Advantage plan at least has an out-of-pocket cap to protect you. For most people, this is what makes Medicare Advantage a better option than Original Medicare alone.
Part C Eligibility
Any Medicare beneficiary, regardless of age, can purchase a plan if they meet the following guidelines:
They must be enrolled in both Medicare Part A and B. You must have both. If you drop one, you will immediately be kicked out of your Medicare Advantage plan.
You must live in the plan's service area. Your eligibility will be based on the address that you have on file with Social Security. You must choose a plan in that area. Some plans will be specific to a couple of counties, while others may cover the entire state.
REMINDER: Medicare Advantage plans have specific election periods. You can enroll during your Initial Enrollment Period or during the Annual Enrollment Period in the fall. In certain circumstances you can get a Special Election Period to enroll in a plan mid-year. These are generally events like moving to a new state or losing your coverage.
What does Medicare Advantage cover?
Medicare Advantage (Part C) covers everything that Part A and Part B cover. However, instead of paying deductibles and the 20% Part B coinsurance for your medical services, you will only pay the plan's copays.
Each plan has a Summary of Benefits. This summary lists all the different medical services covered by the plan. It will show you what your copay or coinsurance will be for each service provided. For example, you might pay $10 to see your primary care physician, $30 to see a specialist, $120 for an emergency room visit, etc. (These are just examples. Be sure to review your Summary of Benefits to see what your cost-share is for each service.)
Some services may have a $0 copay and that means you will have no copay in those situations. The highest amount that you will pay in-network for any services is a 20% coinsurance. This is typically only reserved for things like durable medical equipment, chemotherapy, radiation, and dialysis. Always be sure to review your Summary of Benefits to see what you can expect to pay in any given situation.
Most Medicare Advantage plans include a built-in Part D prescription drug plan at no extra cost to you. This is a great feature to take advantage of. If you do not need prescription drug coverage, many areas have a few Medicare Advantage plans without drug coverage, but since the drug coverage comes at no extra cost, it may be wise to just select a plan that has it.
REMINDER: Everything you spend on Part A and Part B services counts toward your out-of-pocket maximum. If you hit that maximum in a given year, your Part C plan will pay 100% of all costs for the remainder of the year.
Do I need Medicare Advantage?
Medicare Advantage (Part C) is optional, voluntary coverage. You have the option to choose whether you want to enroll in Original Medicare or if you would prefer a Medicare Advantage plan instead. It is your decision as to what is the best fit for you. However, Medicare Advantage plans provide you with a cap on your out-of-pocket expenses, whereas Original Medicare does not.
Medicare Advantage Enrollment Periods
Unlike Medigap (Medicare Supplement) policies, you can only enroll or dis-enroll from a Medicare Advantage plan during certain periods of the year. Your first opportunity to enroll in a Part C Medicare Advantage plan is during your Initial Enrollment Period when you first get Medicare Part B. Remember, you must have, and continue to pay the premium on Part B in order to be eligible for a Medicare Advantage plan. Your other opportunity to enroll or make a change to your Medicare Advantage plan is during the Annual Election Period each fall. It runs each fall from October 15 - December 7th. When you enroll or make a change during this Annual Election Period, your new benefits will start on January 1st.
The reason the Annual Election Period exists is because if you are enrolled in a Medicare Advantage or Part D prescription drug plan, your plan's benefits, formulary, pharmacy network, provider network, premiums and/or co-payments and co-insurance may change on January 1st of each year. Typically you will get an Annual Notice of Change letter in September describing the changes, if any. In the event that you are not satisfied with the changes your plan makes, Medicare wants you to have an opportunity to change your plan for the next year.
Additionally, there are also Special Election Periods for Medicare Advantage plans. These can take place at any time during the year and are typically triggered by life events such as leaving your employer group insurance, moving to a new area, having a new 5-star plan available in your area, etc. There are a couple dozen events that would qualify you for a Special Election Period, so be sure to ask your agent if you qualify for one. If you do qualify for a Special Election Period, you will have 60 days from the date of the event to make a change and your new benefits will begin on the 1st of the month following your date of application. A good agent who specializes in Medicare can help you learn how to qualify for Medicare Advantage and explain the enrollment periods available to you. If you don't have your own agent, we are happy to provide you with a free consultation to answer any of your questions and help you decide on the best coverage for your particular needs. You can click the button at the bottom of the page to schedule your free consultation at a time that works best for you.
Help with Medicare Advantage
Medicare Part C (Medicare Advantage) plans have particular rules, networks, and enrollment periods. Limitations, restrictions, and copays may apply. Working with an experienced agent that specializes in Medicare can help you understand what a Medicare Advantage plan covers and any additional information you may need before your apply for a plan.
Do you need assistance in choosing a Medicare Advantage plan that will be accepted by your doctor and provide affordable benefits to you? We are always happy to help! Call (866) 440-1885 today!
Key Points
When you enroll in a Medicare Advantage plan you are choosing to receive your Medicare benefits through a private insurance company instead of the federal government.
As long as you are enrolled in Part A and Part B, you can apply for a Medicare Advantage plan during any available election period to do so.
You must continue to pay your Part B premium, but you will generally have low or no monthly premium on the Medicare Advantage plan itself.
Medicare Advantage plans offer a maximum out-of-pocket limit to put a cap on your annual costs. Original Medicare doesn't have a cap on out-of-pocket expenses,
© 2025 Mohring Insurance Services LLC All Rights Reserved.
MyMedicareFacts.com is a free-to-use information website by Mohring Insurance Services LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
This is a promotional communication.
Calling our phone number will connect you to a licensed broker who is trained and certified to help you review the plan options available in your area. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact MEDICARE.gov or 1-800-MEDICARE to get information on all your options.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day / 7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.
MyMedicareFacts.com is the web and phone-based insurance portal utilized by Mohring Insurance Services LLC. Beneficiaries may be connected by licensed insurance agents of Mohring Insurance Services LLC who are licensed to transact business as insurance agents in your state.
Not all licensed insurance agents with Mohring Insurance Services LLC are licensed to sell all products. Service and product availability varies by state. Agents of Mohring Insurance Services LLC work with Medicare enrollees to explain Medicare Advantage, Medicare Supplement Insurance, and Prescription Drug Plan options. Agents of Mohring Insurance Services LLC are licensed and certified representatives of Medicare Advantage HMO, PPO, and PPFS organizations and stand-alone prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal.
Licensed insurance agents may be compensated based on a consumer's enrollment in a health plan. No obligation to enroll. Licensed agents cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled.
Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.
Medicare has neither reviewed nor endorsed this information.
Licensed insurance agents required to comply with all applicable federal laws, including the standards established under 45 C.F.R. § 155.220(c) and (d) and standards established under 45 C.F.R. § 155.260 to protect the privacy and security of personally identifiable information.
The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. To learn more about a plan’s nondiscrimination policy, please contact the plan.
For a complete list of available plans please contact 1-800-MEDICARE, TTY 711, 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare beneficiaries may also enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Every year, Medicare evaluates plans based on a 5-star rating system.
You are not required to provide any health related information unless it will be used to determine enrollment eligibility.
MyMedicareFacts.com is not connected with or endorsed by the United States government or the federal Medicare program.
© Mohring Insurance Services LLC. All trademarks and service marks are the property of their respective owners and used with permission.
Rates are reviewed periodically and are subject to change in your state.
Cost Estimates are based on the information entered, using data about past experiences by beneficiaries with similar attributes and the premiums and benefits provided by the plan. Actual costs may vary. Monthly medical costs are represented by annual figures divided evenly per month.
Licensed sales agents/producers may be compensated based on your enrollment in a health plan.
Medicare Supplement Plans are not connected with or endorsed by the U.S. Government or the federal Medicare program.
For plans that provide drug coverage, the formulary may change during the year.
Medicare beneficiaries may also enroll in Medicare plans through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov.