Medicare Plans
Medicare Advantage (Part C) in Palm Beach County
A Medicare Advantage plan is private insurance that takes over from Original Medicare. You're still on Medicare, but the plan pays your hospital and doctor claims and, in most cases, your prescriptions, all on one card.
You usually trade a low premium for copays and a network. In Palm Beach County the network question comes up fast, because the hospitals belong to different systems. Is Boca Raton Regional Hospital in the plan? Jupiter Medical Center? Your cardiologist's group? And if you spend part of the year in another state, what does the plan cover there?
- Plan premiums that are low, and sometimes $0
- A yearly cap on in-network costs
- Drug coverage built into most plans
- Dental, vision and hearing benefits in many plans
Check the network before the premium
List the doctors and hospitals you want to keep. A licensed insurance agent checks them against the Advantage plans we represent in your ZIP code and calls you back during business hours, including any plan that leaves someone out.
What to expect
Free review- A licensed agent calls you back during business hours, Mon-Fri, 9:30am-6:30pm ET
- Your doctors and prescriptions get checked before any plan is suggested
- No fee for our help, and your premium is the same either way
- No obligation to enroll, and no pressure if you'd rather stay put
Reviewed by the licensed insurance agents at Palm Beach Senior Insurance. Last reviewed: October 2026. Office hours: Mon-Fri, 9:30am-6:30pm ET.
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A licensed agent will call you during business hours, Mon-Fri, 9:30am-6:30pm ET. If you'd rather not wait, call 561-000-0000 now.
Plan types
HMO or PPO: the difference shows up at the specialist and out of state
| HMO | PPO | |
|---|---|---|
| Monthly premium | Usually the lowest, often $0 | Somewhat higher |
| Care outside the network | Emergencies and urgent care only | Covered, at a higher cost |
| Referrals | Often needed for specialists | Usually not needed |
| Fits best for | Year-round residents who use one hospital system | People who see doctors in more than one system or travel often |
Look at the network before the price
Hospitals and doctor groups don't sign with every plan every year. We check your doctors, hospital and pharmacy in the current directory before you enroll in anything.
Snowbirds
Advantage plans and part-year residents
An Advantage plan is tied to a service area, and you have to live there to join. If your permanent home is in Palm Beach County, you pick from plans sold here. If your permanent home is up north, your plan comes from there, even during the months you spend in Florida.
While you're away from the service area, the plan must cover emergency care and urgent care anywhere in the U.S., plus dialysis for a short stay. Routine care is another matter. An HMO usually won't pay for a checkup or a specialist visit in your other state. A PPO may pay, at its higher out-of-network rate.
Time away counts too. If you stay out of the service area for more than six months in a row, Medicare rules require the plan to disenroll you. Some plans offer a visitor or traveler benefit that extends this to as long as 12 months, sometimes only for certain states. If you go north every summer, ask about that benefit in writing, or look at Medigap, which has no service area.
Costs
What you pay with Part C
You still owe your Part B premium to Medicare, $202.90 a month in 2026 for most people. The plan may charge its own premium on top, from $0 up. Then you pay copays as you use care: one amount for your family doctor, more for a specialist, and more again for outpatient surgery or a hospital stay.
The yearly out-of-pocket maximum is your protection. Once you hit it, the plan pays in full for covered in-network care until the year ends. Original Medicare has no such limit, which is why people who don't buy a Medigap plan often choose Advantage. Still deciding? Read Advantage vs. Medigap.
- You keep paying the Part B premium
- Most costs are flat copays rather than percentages
- The out-of-pocket maximum limits a costly year
- Benefits, networks and drug lists reset every January 1
Extras
How to judge the extra benefits
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Dental, vision and hearing
These vary widely. A large dental allowance may only apply to certain work, so ask how much the plan pays for a cleaning, a filling and a crown. -
Prescriptions
Most Advantage plans include Part D. Run your actual drugs through the plan's list, since the tier can matter more than the premium. See Part D drug plans. -
Gym, rides and store allowances
Many plans include a fitness membership, an over-the-counter allowance or rides to appointments. They're worth something only if you'll use them.
Timing
When you can join or change plans
Most people join during their Initial Enrollment Period when they're turning 65, or during Annual Open Enrollment, October 15 to December 7. Members of an Advantage plan also get the Medicare Advantage Open Enrollment Period, January 1 to March 31, for one change.
Certain events open a Special Enrollment Period, such as moving your permanent home into or out of the county, losing job coverage, or qualifying for Extra Help. If a declared emergency like a hurricane kept you from making a change during another window, you may also get a special period. Want to leave a plan you're in now? Start with switching your plan.
Prior authorization
Approvals Original Medicare rarely asks for
Many Advantage plans need to approve some services before they'll pay. That can include MRI and CT scans, outpatient surgery, a rehab stay after the hospital, home health care, medical equipment and some specialist visits. Your doctor sends the request and the care waits for the plan's answer.
Most requests are approved, though timing depends on the plan. If one is denied, you can appeal to the plan and then to an independent reviewer. We can help with the appeal.
Original Medicare with a Medigap plan seldom needs prior approval. If avoiding approvals matters more to you than a low premium, say so at the start, because it changes the plans we'd suggest.
Our process
How we check a plan's network for you
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1
You send your list
Your family doctor, each specialist, the hospital you'd want and your pharmacy. A name and a town is enough.
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2
We search next year's directory
We look up every Advantage plan we represent for the coming plan year. This year's directory won't tell you about January.
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3
We call the office when it's unclear
Directories fall behind. A call to the practice's front desk is sometimes the only way to know for sure.
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4
You get a plain answer
Which of our plans keep everyone on your list, which keep some, and what it would cost to see the ones left out.
We do not offer every plan available in your area
We only check plans from the companies we represent. For information on every plan sold in Palm Beach County, contact Medicare.gov, 1-800-MEDICARE, or SHINE (Serving Health Insurance Needs of Elders), Florida's free Medicare counseling program, at 1-800-963-5337.
Local networks
Hospital networks around Palm Beach County
Hospitals here belong to several different systems. Tenet runs St. Mary's and Good Samaritan in West Palm Beach, Palm Beach Gardens Medical Center and Delray Medical Center. Baptist Health runs Boca Raton Regional Hospital and Bethesda Hospital East in Boynton Beach. HCA Florida JFK Hospital is in Atlantis, Wellington Regional Medical Center serves the western communities, and Jupiter Medical Center covers the north end. An Advantage plan might include most of these or only a few. Veterans can also use the Thomas H. Corey VA Medical Center in West Palm Beach. See the towns we cover on our service areas page, or return to the Medicare plans overview.
Fit
When Advantage works, and when it doesn't
It often fits if you
- Live in Palm Beach County all year
- Get most of your care in one hospital system
- Want a low or $0 plan premium
- Like having a firm limit on a costly year
- Would use the dental, vision, hearing or gym benefits
It often doesn't fit if you
- Spend several months a year in another state
- See specialists in more than one hospital system
- Are in treatment and can't risk a network change
- Don't want approvals holding up your care
- Would rather pay one steady premium than copays
Before you sign
Questions to ask about any Advantage plan
Will every doctor I see be in network next year?
What's the out-of-pocket maximum, in dollars?
What happens if I spend the summer in another state?
What are the copays for a specialist, an outpatient surgery and a hospital stay?
Do any of my medications need prior authorization or step therapy?
How do I leave the plan later if it doesn't work out?
Want your doctors checked against our plans?
Send us your doctors and prescriptions. We'll tell you which Advantage plans we represent include them, at no cost to you.