Choose a plan available to you
Check eligibility, service area, doctors, and benefits.
- Who Can Join
- How Plans Work
- Six Plan Types
- Costs and Enrollment
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What is Medicare Advantage?
Medicare Advantage is also called Medicare Part C. It is a Medicare-approved health plan offered by a private insurance company.
The plan provides your covered Medicare health services and sets the network, service rules, and cost-sharing you follow. Plans must meet Medicare requirements, while benefits and details can differ from one plan to another.
Many plans include prescription coverage. Some also offer extra benefits, subject to the plan’s terms and limits.
Follow that plan’s rules
Know the network, referrals, and approval requirements.
Understand your share
Review premiums, copayments, coinsurance, and the yearly limit.
Who qualifies?
Basic eligibility for Part C
To enroll in a Medicare Advantage plan, you generally need to meet all three requirements below.
Be enrolled in Medicare Parts A and B
Most people first become eligible at 65. Some qualify earlier because of disability or certain conditions. You generally continue paying your Part B premium while enrolled in a Medicare Advantage plan.
Live in the plan’s service area
Plans are offered in specific counties and ZIP codes. The plan must serve the area where you live.
Enroll during an allowed period
You can join when first eligible or during another enrollment period that applies to your situation.
Some plans have additional eligibility rules. To review the Medicare Advantage options the Assurance Network offers in your area, call 804-299-4075.
What the plan can do
How Medicare Advantage may help
Depending on the plan, Part C can make it easier to coordinate covered care, manage costs, or access added benefits.
Bring covered care together
Your plan manages most covered medical services, with one member ID card and one set of plan documents and service rules.
Set a yearly limit for covered medical care
Every Medicare Advantage plan has an annual out-of-pocket limit for covered medical services. After you reach it, the plan pays 100% of those covered services for the rest of that calendar year.
Offer benefits beyond routine medical care
Many plans include prescription coverage. Some may also include dental, vision, hearing, fitness, transportation, or over-the-counter benefits. Availability, providers, and limits vary.
Coordinate support for specific needs
Special Needs Plans may tailor care coordination and benefits for people who meet the plan’s eligibility requirements.
Help with a monthly premium in some cases
Some plans may pay all or part of the Part B premium. This is not offered by every plan or in every area, so compare the plan’s full costs.
A practical example
Before you book a specialist visit
First: Confirm the specialist is in the plan’s network.
Next: Ask whether you need a referral or prior authorization.
Then: Check your copay or coinsurance and whether it counts toward the yearly limit.
Three situations to check in the plan documents
Urgent or emergency care
Rules can differ from routine appointments. Know how the plan handles urgent and emergency care, especially when you are away from home.
Travel or time away
Check what care is covered when you spend time outside the plan’s service area and whether the plan offers any travel-related benefits.
Extra benefits
Dental, vision, hearing, and other extras may have limits, approved providers, or specific covered services. Confirm the details before relying on them.
These benefits are not guaranteed in every plan. A $0 plan premium does not mean all care or coverage is free.
Using your coverage
Approvals, coverage decisions, and appeals
Before getting care, learn the plan’s approval rules. If the plan says it will not cover a service, you can ask it to review that decision.
- 01
Check before the appointment
Confirm the provider is in network, ask whether a referral is needed, and find out if the plan requires prior authorization for the service. Requirements vary by plan and service.
- 02
Request a coverage decision
If you are unsure whether a service is covered or how much you will pay, ask your plan for a coverage decision before you receive it. You, your representative, or your provider can ask.
- 03
Appeal if the plan denies coverage
The plan’s notice explains why it denied coverage and how to appeal. Follow the instructions and deadline in the notice. For many initial appeals, the request must reach the plan within 65 days of the denial notice.
If a plan denies coverage, contact the Assurance Network if you need help understanding your options. Call 804-299-4075.
Know the differences
Six Medicare Advantage plan types
Start with the comparison. Tap or click a plan type below to open its explanation and a question to ask. Availability and exact rules depend on the plan and where you live.
| Plan type | Provider access | Referrals | Out-of-network care |
|---|---|---|---|
| HMO | Usually use the plan network for routine care. | May be required. | Usually limited for routine care; check plan rules. |
| HMO-POS | HMO network with possible point-of-service options. | Depends on the plan. | Some listed services may be covered, often at higher cost. |
| PPO | Preferred network; using it generally costs less. | Usually not required. | May be covered at a higher cost. |
| PFFS | Some plans have networks; providers must accept plan terms. | Usually not required. | May be available if the provider accepts the plan’s payment terms. |
| SNP | Uses an HMO or PPO structure. | Depends on the structure and plan. | Depends on whether the SNP is an HMO or PPO. |
| MSA | Generally no provider network. | Usually not required. | Provider must accept the plan’s terms; high deductible applies. |
Exact provider access and costs are plan-specific. The detailed descriptions below explain what to verify.
HMO · Health Maintenance Organization
Usually requires you to use the plan’s network for routine care. You may need to choose a primary care provider and get referrals for specialists. Emergency and urgent care have different rules.
Ask: Are my doctors, hospitals, and pharmacies in this network?
HMO-POS · HMO Point-of-Service
Works like an HMO but may cover some services outside the network, often at a higher cost. Out-of-network benefits may apply only to certain services.
Ask: Which out-of-network services are covered, and what will I pay?
PPO · Preferred Provider Organization
Has a preferred network and may cover care outside it at a higher cost. You generally do not need a primary care provider or a referral to see a specialist.
Ask: What will my out-of-network costs be?
PFFS · Private Fee-for-Service
The plan sets what it pays providers and what you pay. Some PFFS plans have networks. A provider outside the network must accept the plan’s payment terms and agree to treat you for that visit.
Ask: Will this provider accept this exact plan for my visit?
SNP · Special Needs Plan
For people who meet specific eligibility requirements. SNPs use an HMO or PPO structure and tailor coverage and care coordination to the group they serve.
- D-SNP: for people who qualify for both Medicare and Medicaid.
- C-SNP: for people with a qualifying severe or disabling chronic condition covered by that plan.
- I-SNP: for people who live in certain institutions or meet the plan’s institutional-level care requirements.
MSA · Medical Savings Account
Combines a high-deductible plan with a medical savings account funded by the plan. The plan begins paying covered costs after you meet the deductible. These plans do not include Medicare drug coverage; if you want it, you can join a separate Medicare drug plan.
Ask: How does the deductible compare with the account deposit?
Know what you may pay
Medicare Advantage plan costs
Premiums and other costs vary by plan and can change each year. Compare the full cost picture, not only the monthly plan premium.
| Cost to review | What to know |
|---|---|
| Monthly premiums | You must continue paying your Part B premium to stay enrolled. A plan may also charge its own premium. Some plans may help pay all or part of the Part B premium. |
| Deductibles and cost-sharing | Deductibles, copayments, and coinsurance vary by plan and service. Check costs for the care you expect to use, such as specialist visits, hospital care, and tests. |
| Yearly out-of-pocket limit | The limit varies by plan. After you pay the plan’s limit for covered medical services, the plan pays 100% of those services for the rest of the calendar year. |
Cost terms, simply explained
Premium
Regular monthly payment.
Deductible
Amount you pay for certain care before the plan pays its share.
Copayment
Fixed amount for a covered service.
Coinsurance
Percentage of a covered service’s cost you pay.
Plan costs vary by county and year. The Assurance Network can review the options it offers in your area. Call 804-299-4075.
When you can join or change plans
Medicare Advantage enrollment periods
These are the main times people can enroll or make changes. The window that applies depends on your circumstances.
- Around age 65 · 7 months
Initial Enrollment Period
Generally starts 3 months before the month you turn 65 and ends 3 months after it. Some people qualify for Medicare earlier.
- October 15 – December 7
Annual Enrollment Period
You can join, switch, or leave Medicare Advantage coverage. Changes generally take effect January 1.
- January 1 – March 31
Medicare Advantage Open Enrollment
If you are already enrolled in a Medicare Advantage plan, you can switch to another plan or leave Medicare Advantage. You can make one change during this period.
- After a qualifying event
Special Enrollment Period
Events such as moving or losing certain coverage may allow a plan change. Eligibility and deadlines depend on the event.
A simple comparison checklist
Compare plans in five steps
- 1Start with your location. Share your ZIP code with the Assurance Network so we can review the options we offer in your area.
- 2Check your care team. Confirm your doctors, specialists, hospitals, and pharmacies.
- 3Check the benefits you use. Review prescription coverage, extra benefits, and any limits that matter to you.
- 4Estimate the full cost. Compare premiums, copayments, coinsurance, deductibles, and the yearly medical limit.
- 5Read the plan documents. Use the Summary of Benefits and Evidence of Coverage to confirm details before enrolling.
Get ready for your review
Bring the details that matter to you
Your area: ZIP code or county.
Your care: doctors, specialists, hospitals, and services you use.
Your medications: names and preferred pharmacies, if drug coverage matters to you.
Your current coverage: current plan name or member card, if you have one.
Your priorities: benefits you want and the monthly or yearly costs you are comfortable with.
We’ll review the plans the Assurance Network offers in your area, check the details that matter to you, and explain the costs and plan rules.
Enrollment windows depend on your situation. Call the Assurance Network at 804-299-4075 to review your options and timing.
Quick answers
Common questions about Part C
Do all Medicare Advantage plans have the same benefits?
No. Premiums, provider networks, covered extras, cost-sharing, and service rules differ by plan and location.
Can I use any doctor I want?
It depends on the plan. Many plans use provider networks. Some cover care outside the network at a higher cost, while others may not cover routine out-of-network care.
Does every plan include prescription coverage?
No. Many plans include it, but not all. Check the plan’s current coverage details before enrolling.
What if a plan denies a service?
You can request a coverage decision and appeal if you disagree. Follow the instructions and deadlines in the plan’s notice.
Let’s review your Medicare Advantage options together.
The Assurance Network can help you compare the plans we offer in your area, including provider access, benefits, and costs.
This page is for general educational purposes and is not a complete description of any plan’s benefits, costs, or coverage. Plan availability, costs, provider networks, benefits, eligibility, and enrollment rules vary by location and plan and may change. The Assurance Network does not offer every plan available in every area. Call 804-299-4075 to review the Medicare Advantage options the Assurance Network offers in your area. This website is not affiliated with or endorsed by the U.S. government or the federal Medicare program.