What Is Medicare Advantage (Part C)?
Medicare Advantage is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare covers — and most offer additional benefits.
You must have Medicare Parts A & B to enroll in a Medicare Advantage plan, and you'll continue paying your Part B premium.
What Medicare Advantage Plans Typically Include
Hospital & Medical
All Part A & B services
Prescription Drugs
Most MA plans include Part D
Dental
Routine dental coverage
Vision
Eye exams & eyewear
Hearing
Hearing exams & aids
Fitness
Gym memberships (SilverSneakers)
Medicare Advantage vs. Original Medicare + Medigap
| Factor | Medicare Advantage | Original + Medigap |
|---|---|---|
| Monthly Premium | $0–$50/mo (+ Part B) | $100–$300/mo (Medigap + Part D + Part B) |
| Provider Choice | Network-based (HMO/PPO) | Any Medicare-accepting provider |
| Out-of-Pocket Max | Required by law (typically $3,000–$8,000) | No cap unless Medigap |
| Drug Coverage | Usually included | Separate Part D plan needed |
| Extra Benefits | Dental, vision, hearing, fitness | None included |
| Best For | Budget-conscious, healthy, local care | Travelers, chronic conditions, flexibility |
HMO vs. PPO — Network Types Explained
- HMO (Health Maintenance Organization): Must use in-network providers. Usually requires a primary care physician referral to see specialists. Lower premiums.
- PPO (Preferred Provider Organization): Can see out-of-network providers at higher cost. No referrals needed. More flexibility, slightly higher premiums.
In Jacksonville, we know which plans include Baptist Health, Mayo Clinic, UF Health, and Ascension St. Vincent's in their networks. We'll help you find a plan that works with your doctors.
Local Jacksonville MA Plan Considerations
Medicare Advantage plans vary by ZIP code. The plans available in Duval County may differ from those in Clay, St. Johns, or Nassau counties. We compare all available plans in your area to find the best fit for your needs, budget, and preferred providers.
Frequently Asked Questions
Yes. During the Annual Enrollment Period (Oct 15 – Dec 7) or the Open Enrollment Period (Jan 1 – Mar 31), you can switch back to Original Medicare. However, you may not be guaranteed acceptance into a Medigap plan depending on your state and health history.
Many MA plans do have $0 monthly premiums — but you still pay your Part B premium. You'll also have copays, coinsurance, and deductibles when you use services. We help you understand the total cost, not just the premium.
Most MA plans include Part D drug coverage. We'll review your medications against each plan's formulary to make sure your drugs are covered at the lowest cost.
If your doctor is out of network, you may pay more or the visit may not be covered at all (depending on HMO vs PPO). We always check your providers against plan networks before recommending anything.
It depends. Some MA plans offer Special Needs Plans (C-SNPs) designed specifically for chronic conditions. However, if you need frequent specialist care or travel often, Original Medicare + Medigap may offer more flexibility.