Medicare Advantage (Part C)
I'm Erick Vallarino, an insurance agent serving all of Texas, and I live and work here in the Valley. Medicare Advantage is one way to get your Medicare: one plan from a private company, with one card to show. Here is how it works, who it can fit, and what to check before you choose. My help costs you nothing.
One plan that bundles your Medicare.
Medicare Advantage is also called Part C. It is a plan from a private insurance company, approved by Medicare.
It bundles your Part A and Part B into one plan, and you still get everything they cover. Most plans also include drug coverage, plus extra benefits that Original Medicare does not cover, like some dental, vision and hearing care, and more. Each plan has a yearly limit on your out-of-pocket costs for covered Part A and Part B services. Drug costs follow separate rules.
You still have Medicare. To join, you need both Part A and Part B, and you have to live where the plan is offered. Then you show the plan's card when you get care.
- APart AHospital stays
- BPart BDoctor visits, tests and preventive care
- DPart DDrug coverage, included in most plans
- ExtrasIn most plans: some dental, vision and hearing care, and more
- CPart C: Medicare AdvantageAll in one plan, with one card to show
HMO or PPO? Here is the difference.
Most plans have a network: the doctors, hospitals and pharmacies that work with the plan. The two most common kinds handle it differently.
Stay inside the network.
- You usually use the doctors and hospitals in the plan's network.
- You often pick one main doctor, and you may need a referral to see a specialist.
- Care outside the network is usually not covered, except in an emergency, for urgent care, or for kidney dialysis while you're temporarily away from the plan's area.
More room to go outside.
- You can see doctors in the network and outside it.
- Going outside the network usually costs you more.
- You usually do not need a referral to see a specialist.
Every plan has its own rules. I read them with you before you choose.
What comes with a plan.
You still get everything Parts A and B cover. Here is what else to know, and what 2027 plans here in the Valley include. The details are different in each plan, so I read them with you.
A yearly limit on what you pay
Every Medicare Advantage plan has a yearly limit on what you pay for covered Medicare services, like hospital stays and doctor visits. Original Medicare has no yearly limit unless you add supplemental coverage. Until then, you pay copays or a share of the cost, and each plan sets its own limit. Once you reach your plan's limit, you pay nothing more for those covered services for the rest of the year. A PPO has an in-network limit and a combined limit for covered care inside and outside the network. The combined limit can be the same or higher. Your premiums don't count toward the limit, and drug costs follow separate rules.
Premiums, drugs and doctor visits
For 2027, most Medicare Advantage plans in the Valley have no monthly plan premium. You still pay your Part B premium.
For 2027, most Medicare Advantage plans in the Valley have no yearly deductible for medical care and no copay to see your primary care doctor in the plan's network.
For 2027, most Medicare Advantage plans in the Valley include Part D drug coverage. Some do not, so if you take medicines, that is one of the first things I check.
For 2027, some Medicare Advantage plans in the Valley lower the Part B premium you pay each month. Many people call this a Part B giveback. Some of these plans do not include drug coverage, so I go over the whole plan with you. If Medicaid or a Medicare Savings Program already pays your Part B premium, this reduction usually doesn't go to you.
Dental, vision and hearing
For 2027, most Medicare Advantage plans in the Valley include dental, vision and hearing benefits. Most also help pay for fillings, glasses and hearing aids.
For 2027, some Medicare Advantage plans in the Valley include dental benefits that can pay thousands of dollars a year toward your dental care. Each plan has its own limits and rules. Dental coverage is very different from plan to plan.
Care when you travel, and in Mexico
Emergency and urgent care are covered anywhere in the U.S., even outside the network. Other care away from home depends on the plan, and a PPO may cover more of it, often for more. For 2027, many Medicare Advantage plans in the Valley cover emergency and urgent care outside the United States, including in Mexico. Some don't, so if you go to Mexico, that is one of the first things I check. This is for emergencies, not routine care, and each plan sets its own limits. You may have to pay first and then ask the plan to pay you back.
Plans with these benefits are offered in the Valley by companies I'm contracted with: Aetna Medicare, HealthSpring, Humana, Prominence Health Plan, UnitedHealthcare and Wellcare. Not every company offers every one of these benefits.
Who it can fit, and what to know first.
Based on my September 2026 client records, most of my current Medicare clients are enrolled in a Medicare Advantage plan. Still, it isn't right for everybody, so we start with your doctors and your medicines.
Medicare Advantage can fit you if
- You like one plan and one card for your Medicare.
- You want your drug coverage in the same plan.
- You want a yearly limit on what you pay for covered Medicare services.
- Your doctors and hospital are in the plan's network.
- You get most of your care close to home.
- You'd like extras, like some dental, vision and hearing care, in the same plan.
Sounds like you? Call or text me at 956-564-2557, and I'll look up your doctors and medicines.
Good to know first
- You may need a referral to see a specialist, or the plan's OK before some care.
- You generally keep paying your Part B premium, unless Medicaid or a Medicare Savings Program pays it for you. Some plans also have a monthly premium. You may pay copays or a share of care costs, depending on your plan and any help you qualify for.
- A doctor can leave a plan's network during the year, and plans can change their drug list and costs every year, so we look again each fall.
- Have a Medicare Supplement now? Call me before you drop it. You may not be able to get it back later. If it's your first time in a Medicare Advantage plan, you may be able to get it back within the first 12 months.
Check your doctors and medicines first.
This step matters most. A plan can look good and still be wrong for you if your doctor is not in it, or your medicine is not on its list.
Bring your list of doctors and medicines, or just your pill bottles. I look it all up before you choose, not after the bill comes.
- Are my doctors, my specialists and my hospital in the network?
- Are my medicines on the plan's drug list?
- Which pharmacies can I use?
- Do I need a referral to see a specialist?
- What will I pay at the doctor and at the pharmacy?
- Does the plan include the extras I care about, like dental or hearing?
- What if I travel, or spend time away from home?
Plans change every year. So we look again.
A plan can change its doctors, its drug list and its costs. In the fall, your plan mails you a letter about what is changing. Most people put it in a drawer.
That's where I come in. Every fall, we go over what changes for you, in plain words. If your plan still fits, I'll tell you to keep it.
The time to change your Medicare Advantage or drug plan for next year.
Special Needs Plans.
Some Medicare Advantage plans are made for people with certain needs. Not everyone can join one. If you might qualify, I'll check with you.
Medicare and Medicaid
For people who have both. These plans help your Medicare and your Medicaid work together.
Certain long-term conditions
For people with certain ongoing health problems, like diabetes or some heart problems.
Nursing home level of care
For people who live in a nursing home, or need that level of care at home.
I do the checking. You make the choice.
I'm an independent agent, and I don't work for just one insurance company. For Medicare Advantage and drug plans, I'm contracted with Aetna Medicare, HealthSpring, Humana, Prominence Health Plan, UnitedHealthcare and Wellcare. My help costs you nothing.
We talk first
Tell me about your doctors, your medicines and what matters to you. In English or Spanish, at your kitchen table or at an office near you.
I check what fits
I look up your doctors and medicines in the plans I offer. If a Medicare Supplement or another kind of coverage fits you better, I'll tell you.
I'm your agent all year
After you sign up, you still call me. Bills, doctors, letters, questions. You call me, not a 1‑800 number.
Want extra protection next to your plan? Some of my clients add a hospital or cancer policy that pays money to them, or a dental policy. These are not Medicare plans, and you never need one to keep your plan. See how they work.
Advantage or Supplement?
- Medicare Advantage (Part C)
- One plan and one card for your Medicare. You show your plan’s card when you get care.
- Most plans include drug coverage. Always check that your medicines are on the plan’s list.
- Every plan has a yearly limit on what you pay for covered Part A and B services. Original Medicare by itself has no yearly limit.
- Medicare Supplement (Medigap, with Original Medicare)
- Any doctor or hospital in the U.S. that takes Medicare. In general, there’s no network to learn.
- Plans go by letters, and the same letter covers the same things. So you compare the price and the company.
- You add a separate drug plan. Supplements sold today don’t include drug coverage.
Short answers.
Don't see yours? Call or text me.
Can a plan turn me down because of my health?
No. If you have Part A and Part B and live where the plan is offered, a Medicare Advantage plan can't turn you down or charge you more because of your health. Special Needs Plans are only for people who qualify for them.
What if my doctor leaves the plan?
Doctors can join or leave a network during the year. If your doctor leaves, the plan should let you know, and it can help you find another one. If a plan's network changes a lot, Medicare may give you a chance to switch plans. Call me, and we'll look at your choices.
Do I have to sign up again every year?
No. Your plan continues each year unless you change it or the plan ends. Each fall, the plan sends you a letter about next year's changes, and we go over it together before December 7.
Thinking about Medicare Advantage? Let's check it together.
Call or text me with your list of doctors and medicines, and I'll look them up in the Medicare Advantage plans I offer. You don't have to sign up for anything. We'll see what fits you, with no pressure and no rush.