Somerset, Kentucky
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Somerset, KY 42501
(606) 678-0540

A Guide to Medicare Advantage October 17, 2020

Somerset, Pulaski
A Guide to Medicare Advantage, Somerset, Kentucky

While Medicare provides hospital and medical coverage, it doesn’t offer coverage for prescriptions and other healthcare services that many elderly individuals need to stay mentally and physically fit. Instead of adding on supplement after supplement—which can end up costing too much for those on fixed incomes—to complete your healthcare coverage, consider a Medicare Advantage plan.

What Is Medicare Advantage?

Also known as Part C, this insurance option offers the benefits of Original Medicare (Part A and Part B) in addition to prescription drug coverage (Part D) and supplemental programs under one convenient plan offered by a private insurance company. This provides a more personalized plan to ensure you have coverage for all necessary medical services without paying additional costs for supplemental programs. 

What Are the Benefits of Medicare Advantage?

medicarePart C coordinates all of your insurance coverage into one plan that’s easy to manage. Depending on the plan, you can also get coverage for prescription drugs as well as hearing, vision, dental, and wellness programs. Some also cover over-the-counter medications, medical transportation, and medical equipment. 

You will also have all of the benefits from Part A and B and all of the protections provided through the Medicare program. Depending on the plan and your needs, you may also qualify for subsidies to get help paying for the premiums. 

What Types of Medicare Advantage Plans Are Available?

Part C is often available through HMO, PPO, or PFFS plans. Seniors on fixed incomes should look into an HMO plan initially as the costs are typically lower. However, there can be some limitations on network providers, and going outside of the network can end up costing more. 

A PPO plan has higher premiums but offers more flexibility about providers. While a referral isn’t required for seeing a specialist, you will have to pay more for going outside of the preferred network.

Under a PFFS plan, the insurance company—not Medicare—determines how much it pays the provider and how much you owe for each covered service. However, you don’t have to choose a primary care physician and do not need a referral to see a specialist. 

When considering any plan, compare the benefits of each one and check its network availability in your area. Also, determine if you are allowed to change doctors, which medications are covered, and if the plan does not cover the needed treatments. Look at the monthly premium, annual deductible, copays, and coinsurance to determine total coverage costs.


If you want to simplify your Medicare plan, the experts at Toohey Insurance Services can help. Since 1983, this insurance company has sought to provide low-cost health insurance throughout Somerset, KY, and the surrounding areas. They partner with all major health insurance companies and stay well-informed of current Medicare options and benefits. Call them at (606) 678-0540 to find out how you can personalize your insurance to suit your needs, and visit their website to learn more about their different options. 

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