Home | Understanding Medicare Advantage Plan Options
We’re Here to Help You Find the Right Coverage
Navigating Medicare Advantage options can be complex and missing enrollment periods may cause penalty fees. As a licensed independent and employee-owned brokerage since 1988 (License #0564249), Heffernan Medicare agents serve to simplify the process to help you compare Medicare Advantage plans that cover your doctors, prescriptions, and hospitals needs.
Connect with a Heffernan licensed Medicare broker today.
By submitting, you agree to be contacted about Medicare plan options. No obligation.
Medicare Advantage (Part C)
What is it?
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are Medicare-approved plans covering Medicare Part A and Part B. They’re offered by private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans. Each Medicare Advantage Plan types has special rules about how you get your Medicare-covered Part A and B services and any supplemental benefits your plan covers. If you join a Medicare Advantage Plan you’ll still have Medicare, but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Additional Medicare Advantage benefits, including dental and vision, may be included depending on the plan.
You’ll have the same rights and protections you would have under Original Medicare. You must use the card from your Medicare Advantage Plan to get your Medicare covered services. Keep your red, white, and blue Medicare card in a safe place because you may need to show your Medicare card for some services. Also, you’ll need it if you ever switch back to Original Medicare.
Key enrollment periods to be aware of:
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday. If you enroll before your 65th birthday, coverage starts the first day of your birthday month; if during or after, it starts the following month.
- Annual Enrollment Period (Oct 15 – Dec 7): Existing beneficiaries can switch between Original Medicare and Medicare Advantage, or change Part D drug plans.
- General Enrollment Period (Jan 1 – Mar 31): For those who missed their IEP, allowing them to sign up for Part A and B, usually with late penalties.
- Special Enrollment Period (SEP): Allows sign-up outside standard times, often for those who lose employer coverage (8-month window) or experience specific life events (e.g., relocation, losing Medicaid).
Different Medicare Plans and Options
Medicare Advantage
Medicare Advantage (Part C) combines Part A and Part B in one plan and may include extra benefits
Medigap
Medigap (Medicare Supplement Plans) works with Original Medicare to help reduce out-of-pocket costs
Medicare Part D
Medicare Part D prescription drug plans secure prescription drug coverage not covered by Original Medicare
Key Questions We’ll Help Answer
Are my doctors in-network?
Our Medicare agents will help you check plan network rules and provider participation (when applicable).
What’s my total cost—not just the premium?
Premiums, copays, deductibles, and maximum out-of-pocket can vary by plan.
Can I go out of network if I need to?
That depends on the plan. PPOs may allow out-of-network care at a higher cost, while HMOs usually require in-network care except for emergencies
Can I switch Medicare Advantage plans later if my needs change?
There are specific enrollment periods when you may be able to join, switch, or drop a Medicare Advantage plan.
Do I need drug coverage included?
Many MA plans include Part D; our Medicare advisors will confirm how drug coverage works in the options you’re reviewing.
Are all Medicare Advantage plans the same in every county?
No—plan availability, provider networks, costs, and extra benefits can all vary based on where you live.
Speak With a Heffernan Licensed Medicare Advisor
Submit the form below and a licensed Medicare agent (license #0564249) will reach out to discuss your Medicare Advantage plan options, help you enroll in Medicare Advantage, and provide application assistance.
“By submitting, you agree to be contacted about Medicare plan options. No obligation.”
Medicare Guidance
What To Expect From a Licensed Medicare Broker
We are committed to educating our clients on their Medicare options so they can obtain the full value of their coverage with guidance from a Medicare consultant. The right Medicare plan for someone else may not be the best Medicare plan for you.
Here’s how our Medicare agents help:
- We confirm your state (CA/MO/WA) and what you’re trying to solve (switch, enroll, or review).
- We learn what matters most (doctors, prescriptions, budget, travel, benefits).
- We review Medicare Advantage plans available in your area and near you and help you compare Medicare Advantage plans while talking through tradeoffs.
- You decide next steps—no pressure.
Licensed Broker – Medicare
Drew Stitz, Senior Vice President
Drew has been a licensed broker since 1989. He’s built his expertise through the years by consulting, implementing, and servicing group employer health, individual health and Medicare insurance clients.
Heffernan Insurance Brokers acquired Drew’s brokerage in 2023 and he joined as a Senior Vice President. He continues to bring his experience and expertise in Medicare to Heffernan’s trusted clients everyday.
Frequently Asked Questions
What is a Medicare Advantage plan (Part C)?
A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are Medicare-approved plans. They’re offered by private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans. Each Medicare Advantage Plan types has special rules about how you get your Medicare-covered Part A and B services and any supplemental benefits your plan covers. If you join a Medicare Advantage Plan you’ll still have Medicare, but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
You’ll have the same rights and protections you would have under Original Medicare. You must use the card from your Medicare Advantage Plan to get your Medicare covered services. Keep your red, white, and blue Medicare card in a safe place because you may need to show your Medicare card for some services. Also, you’ll need it if you ever switch back to Original Medicare.
How do Medicare Advantage Plans work?
When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the private company offering your Medicare Advantage Plan. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to use a specialist or whether you have to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of Open Enrollment for the next year through the Annual Notice of Change, typically mailed to you before September 30 (Open Enrollment is October 15 – December 7 every year).
Do Medicare Advantage plans include prescription drug coverage (Part D)?
Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don’t include Medicare drug coverage (like Medical Savings Account Plans and some Private Fee-for-Service Plans), you can join a separate Medicare drug plan. However, if you join a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) Plan without drug coverage, you can’t join a separate Medicare drug plan.
Can a Medicare Advantage plan include dental or vision benefits?
Some Medicare Advantage plans may include extra benefits like dental, vision, or hearing. Benefits vary by plan and location, so we review what’s available in your area.
What’s the difference between an HMO and a PPO Medicare Advantage plan?
Do Medicare Advantage plans have a maximum out-of-pocket limit?
Medicare Advantage plans have an out-of-pocket limit that varies by plan; once you reach it for covered services, the plan pays 100% for covered services for the rest of the year.
How do I check if my doctors are in-network?
Networks vary by plan and plan type. We’ll help you confirm whether your doctors and hospitals are part of the plan network and what the rules are for out-of-network care.
What’s the difference between a deductible, coinsurance, copayment, and a maximum out-of-pocket limit?
- Deductible: The amount you must pay for health care or prescriptions before Original Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your other insurance begins to pay.
- Coinsurance: An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
- Copayment: An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.
- Maximum Out-of-Pocket Limit: Plans have a yearly limit on what you pay out of pocket for services Part A and Part B cover. Once you reach your plan’s limit, you’ll pay nothing for Part A and Part B services the plan covers for the rest of the year.
When can I enroll in or change a Medicare Advantage plan?
There are specific enrollment periods when you can join, drop, or switch Medicare Advantage plans. See below for the four key enrollment periods:
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday. If you enroll before your 65th birthday, coverage starts the first day of your birthday month; if during or after, it starts the following month.
- Annual Enrollment Period (Oct 15 – Dec 7): Existing beneficiaries can switch between Original Medicare and Medicare Advantage, or change Part D drug plans.
- General Enrollment Period (Jan 1 – Mar 31): For those who missed their IEP, allowing them to sign up for Part A and B, usually with late penalties.
- Special Enrollment Period (SEP): Allows sign-up outside standard times, often for those who lose employer coverage (8-month window) or experience specific life events (e.g., relocation, losing Medicaid).
Do you offer Medicare Advantage help outside CA, MO, and WA?
No—our licensed service area for this program is California, Missouri, and Washington.
Are you affiliated with Medicare or the government?
No. We are licensed Medicare agents but are not affiliated with or endorsed by Medicare or any government agency.
What information should I have ready for the call back?
It helps to know your state/county, whether you want to keep specific doctors, and whether you take prescriptions (and preferred pharmacy). We can still start without this info.
This website is owned by Heffernan Insurance Brokers. Heffernan Insurance Brokers is a licensed insurance agency and is not affiliated with, endorsed by, or connected with the U.S. government, the federal Medicare program, or the Centers for Medicare & Medicaid Services.
We do not offer every plan available in your area. Please contact www.medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or your local State Health Insurance Program (SHIP) to get information on all of your options.
Plan availability, premiums, benefits, and provider networks vary by carrier and service area.
By clicking ‘Submit’, you agree to be contacted by a licensed Heffernan insurance agent by phone, email, or text about Medicare Advantage, Medicare Supplement, and Part D plan options.
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