What is Medicare Advantage (Part C)?

Medicare Advantage, or Part C, is a private plan that runs the Medicare you already have. Here is how it works and what it asks of you.

Updated September 3, 2026 · 4 min read · by Gerino Alejos

A doctor's hand holds out a stethoscope beside the words Medicare Advantage on a dark blue background. — A private plan that takes over administering your Medicare. You enroll in Part A and Part B first, then choose a plan approved by Medicare.

Key points

Medicare Advantage, also called Part C, is a private plan that runs your Medicare for you, and you stay on Medicare the whole time.
You sign up for Part A and Part B first, then pick a plan Medicare has approved, and you keep paying your Part B premium.
Every plan caps what you can pay in a year for covered care inside its network, and after that the plan pays 100 percent.

Medicare Advantage, also called Part C, is not extra coverage added on top of Medicare. It is a private plan that runs the Medicare you already have. You stay on Medicare the whole time.

How Medicare Advantage works

You sign up for Part A and Part B first. Part A is the hospital side. Part B pays for doctor visits and outpatient care, meaning care you get without staying overnight.

Then you pick a private plan that Medicare has approved. Medicare pays that plan a set amount every month to look after you. See how to enroll in an Advantage plan.

You keep paying your Part B premium, the monthly bill for that part of Medicare. What changes is who pays your bills and what you have to do to get care approved.

You are not leaving Medicare when you join an Advantage plan. Some people think they are giving up Medicare. Others think it is a second policy on top of Medicare. Neither is right.

What the plan must cover

Every Advantage plan has to cover everything Original Medicare covers. Original Medicare is the government version, Part A and Part B, with no private plan in the middle.

One thing does not move. Hospice, the comfort care for someone near the end of life, stays with Original Medicare even after you join a plan.

Past that floor, plans compete by adding things Medicare does not cover at all.

Prescription drug coverage, built into most plans.
Money toward dental, vision and hearing care.
Fitness benefits.
An allowance for over the counter items, the pharmacy goods you buy without a prescription.
Rides to medical appointments, on some plans.
On some plans, a credit back toward your Part B premium.

What the plan asks in return: networks and approvals

In exchange, the plan asks you to work inside its rules.

A network, the list of doctors and hospitals the plan has contracts with. Go outside it and you pay more, or on some plans have no coverage at all.
A referral on most HMO plans, your regular doctor's written go ahead before you see a specialist.
Prior authorization on many services, meaning the plan must approve the care before you get it.
Copays as you use care, a set dollar amount at each visit, instead of a large monthly premium.

That last one is the real trade. A supplement, the Medigap policy that pays your share of the bills under Original Medicare, charges you every month whether you see a doctor or not. An Advantage plan charges you as you use care, up to a yearly limit.

Many plans here charge no premium of their own. See what a zero premium plan really means.

The out of pocket maximum

Every Advantage plan sets a yearly cap on what you can pay for covered care inside its network. That cap is the out of pocket maximum. Once your copays reach it, the plan pays 100 percent for the rest of the year.

Original Medicare by itself has no cap like that. Your share of the bills just keeps going. That is the strongest argument for an Advantage plan over Medicare alone. See the full comparison.

The plan types: HMO, PPO and special needs plans

HMO, or Health Maintenance Organization. You use the network only and you need referrals. It usually costs the least, and it is the most common type here.
PPO, or Preferred Provider Organization. Care outside the network is still covered, at a higher cost to you. You get more freedom, and the premium is usually higher.
SNP, or Special Needs Plan. These are open only to people in a certain situation, such as having Medicare and Medicaid at the same time. See plans for people with both.

Read the HMO and PPO comparison before you decide one type beats the other.

Why so many people here have one

Hidalgo County has one of the highest Advantage sign up rates in the country, well above the Texas average. Plenty of plans compete here, and many charge no added premium.

Local networks are deep, and that is a real part of the reason. When the doctors you already see are inside the plan's network, the biggest drawback mostly goes away.

That does not make it right for everyone. Read the drawbacks of Medicare Advantage before you sign anything.

For help deciding whether an Advantage plan fits you, see your Medicare options, call our McAllen office at (956) 687 3334, or enter your ZIP code in the form on this page.

Common follow-up questions

Am I still on Medicare if I have an Advantage plan?

Yes. You stay enrolled in Part A and Part B, and you keep paying your Part B premium. The plan runs your coverage for you.

Do I need a Medigap policy too?

No, and you are not allowed to carry one. A Medigap policy, which pays your share of the bills, only works with Original Medicare.

Is hospice covered by my Advantage plan?

Hospice stays with Original Medicare even while you are in an Advantage plan. That one benefit does not move over to the plan.

Want this looked at properly?

We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.

Call (956) 687 3334

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