Medicare Advantage (Part C)
Medicare Advantage Plans (Part C) — Cole Insure - Kansas City, MO
At Cole Insure, we help individuals nationwide — and right here in Kansas City, Missouri — confidently choose the right Medicare Advantage Plan (Part C) for their needs. These all-in-one plans, offered by private insurance companies, combine your Part A (hospital) and Part B (medical)
benefits, often with extra perks like dental, vision, hearing, and prescription drug coverage.
With so many options, costs, and coverage levels available, it’s easy to feel overwhelmed. That’s why our team provides clear, pressure-free guidance to help you make the best Medicare decision for your lifestyle and budget.
What Is Medicare Advantage?
Medicare Advantage, also known as Part C, is an alternative to Original Medicare. These plans are regulated by Medicare, but administered by private insurers. They’re required to offer the same core coverage as Original Medicare — and many include Part D (prescription drug coverage) and additional services at no extra cost.
Key Benefits of Medicare Advantage:
- Combines Part A + B into one plan
- Often includes prescription drug coverage (Part D)
- May offer vision, dental, and hearing benefits
- Includes wellness programs (e.g., SilverSneakers)
- Offers annual out-of-pocket maximums for added financial protection
Types of Medicare Advantage Plans:
Choosing the right Medicare Advantage plan depends on your health needs, preferred doctors, and where you live. At Cole Insure, we help you compare and enroll in the right plan for your situation. The main types of Medicare Advantage plans include:
- HMO (Health Maintenance Organization) – Lower costs and coordinated care through a network of local providers. Referrals are typically required.
- PPO (Preferred Provider Organization) – More flexibility to see providers in or out of network without needing referrals.
- PFFS (Private Fee-for-Service) – Allows you to see any provider who accepts the plan’s payment terms. No primary doctor or referrals required.
- SNP (Special Needs Plans) – Tailored coverage for people with chronic conditions, dual eligibility (Medicare & Medicaid), or those in long-term care.
HMO (Health Maintenance Organization) Plans
A Medicare Advantage HMO plan is a popular option for individuals looking to receive their Medicare benefits through a managed network. Offered by private insurance companies approved by Medicare, HMO plans combine the services covered under Original Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan. Most of these plans also include Medicare Part D, which provides prescription drug coverage, and many offer additional benefits such as dental, vision, hearing, fitness memberships, and
wellness programs not typically available under Original Medicare.
To enroll in a Medicare Advantage HMO plan, you must already be enrolled in both Medicare Part A and Part B and reside within the service area of the plan. HMO plans work by giving you access to a network of doctors, hospitals, and other healthcare providers who have agreed to treat plan members under specific terms. When you join an HMO, you are usually required to choose a primary care physician who will coordinate your overall care. If you need to see a specialist, a referral from your primary doctor is typically required. This system is designed to streamline care and reduce unnecessary services while keeping costs more predictable.
One of the defining aspects of an HMO Medicare Advantage plan is that it only covers care provided by in-network providers, except in the case of emergencies or urgent care when traveling. If you receive services from a provider outside the network
, you may be responsible for the full cost of that care. Because of this structure, HMO plans often have lower monthly premiums and
reduced out-of-pocket costs compared to other types of Medicare Advantage plans. These plans usually include a fixed copayment for doctor visits, and many come with low or zero deductibles. After your deductible is met, you may be responsible for a percentage of the Medicare-approved costs, but every HMO Advantage plan comes with a built-in out-of-pocket maximum that caps your yearly expenses, offering financial protection beyond what Original Medicare provides.
Choosing an HMO plan means you only need to manage one coordinated policy that includes hospital, medical, and often drug coverage. It’s a simple and affordable way to handle your healthcare and often provides extra services tailored to your lifestyle and wellness goals. At Cole Insure, we help clients compare Medicare Advantage HMO plans to find the one that fits their needs, ensuring they understand their coverage and provider network options before enrolling. Whether you live in Kansas City or elsewhere in the U.S., we provide clear, personal support to help you make the right Medicare decision.
Click here to apply for a Medicare Advantage HMO plan or schedule a free consultation with our team.
PPO (Preferred Provider Organization)
PPO (Preferred Provider Organization) Medicare Advantage plans are one of the most flexible options available under Medicare Part C. Offered by private insurance companies approved by Medicare, these plans allow you to receive care from a wide range of doctors, specialists, and hospitals. Unlike HMO plans, PPOs do not require you to choose a primary care doctor or get a referral to see a specialist. You can use in-network or out-of-network providers, though staying in-network will usually result in lower costs.
Every PPO plan is required to cover at least the same services as Original Medicare Parts A and B, including inpatient and outpatient care. Most PPO plans also include Part D prescription drug coverage, and many offer additional benefits such as dental, vision, hearing services, fitness memberships, transportation to medical appointments, and home-delivered meals after a hospital stay. These extra features vary by plan and provider.
Costs for PPO Medicare Advantage plans can include monthly premiums, deductibles, copayments, and coinsurance. While many plans offer $0 premiums, you may still be responsible for the Medicare Part B premium and out-of-pocket costs for services you receive. One of the key protections of a PPO plan is the annual out-of-pocket maximum, which limits how much you pay for covered services in a given year. After reaching this limit, your plan covers 100% of your approved medical expenses.
The main appeal of a PPO plan is the freedom to choose your healthcare providers, even outside your plan’s network. While you can visit out-of-network doctors or facilities, it’s important to note that your costs will usually be higher compared to in-network care. Still, this flexibility makes PPO plans a great option for people who travel, live in multiple states throughout the year, or simply want more control over their healthcare choices.
A Medicare Advantage PPO plan could be a smart solution if you value provider flexibility and want access to extra benefits all in one plan. At Cole Insure, we help you compare available PPO plans based on your budget, preferred doctors, medications, and location — all with zero pressure and clear guidance. Whether you’re in Kansas City or another part of the country, we’re here to help you enroll with confidence.
Click here to apply for a Medicare Advantage PPO plan or schedule a free consultation with one of our licensed agents.
PFFS (Private Fee-for-Service)
PFFS (Private Fee-for-Service) Medicare Advantage plans offer more flexibility than some other plan types. These plans may have a
network of providers, but you’re typically allowed to see any Medicare-approved doctor or facility that agrees to accept the plan’s payment terms and conditions. You are not required to choose a primary care physician and do not need referrals to see specialists.
Some PFFS plans include prescription drug coverage, while others do not — in that case, you can enroll in a separate Medicare Part D
plan. It’s important to note that if you receive care from providers who don’t accept the plan, you may be responsible for the full cost of services, unless it’s an emergency.
Click here to apply for a Medicare Advantage PFFS plan or contact Cole Insure for help reviewing your options.
SNP (Special Needs Plans) are specialized Medicare Advantage plans designed for individuals with specific health conditions or personal circumstances. These plans tailor their coverage, provider networks, and prescription drug formularies to meet the needs of the group they serve. SNP plans are available to people who are eligible for both Medicare and Medicaid, have certain chronic illnesses
like diabetes, heart failure, ESRD, or dementia, or live in institutional settings such as nursing homes.
All SNP plans include Medicare Part D prescription drug coverage, and they require members to have a primary care doctor. You’ll typically need referrals to see specialists, helping ensure coordinated, condition-specific care.
If you qualify, you can join an SNP plan at any time during the year. Click here to apply for a Medicare Advantage SNP plan
or speak with Cole Insure for personalized help reviewing your eligibility and plan options.
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