2025 Medicare Advantage
Medicare Advantage vs. Medicare Supplement
Get more out of Medicare with Medicare Advantage.
Medicare Advantage Medicare Supplement
Comfort of having an in-network primary care provider to oversee all your care.
Generally gives you the flexibility to see any doctor who accepts Original Medicare.
Replaces Original Medicare.
Supplements Original Medicare.
May cover benefits that Original Medicare doesn’t.
Only covers expenses covered by Original Medicare.
No medical underwriting.
Medical underwriting. (Except for guaranteed issue plans.)
Lower premiums than Medicare Supplement plans.
Higher premiums than Medicare Advantage plans.
Who pays in what order: health plan, you.
Not age- or tobacco-rated.
Who pays in what order: Original Medicare, health plan, you. Age- and tobacco-rated.
Plan Costs Office Visits
Key: This is a summary of commonly used benefits.
IN means in network.
» Non-emergency cost-sharing may vary. Contact the plan for details.
*** Emergency care available worldwide.
+ Also called convenient or walk-in care.
& Dollar amounts listed for inpatient hospital care and SNF are amounts you pay per day.
Perks and Programs
Dental Coverage
Get covered preventive dental services, including one cleaning and fluoride treatment every six months, and one full set of X-rays every three years.
Vision Coverage
Get coverage for one routine eye exam yearly (copayment applies; see the Summary of Benefits for specific copayment amounts) and a $75 allowance for eyewear every two years.
Fitness Benefit
Get fit with the help of our fitness benefit for no cost. Get access to a variety of fitness options and community events. Keep your routine or add to it. You decide how to stay active and healthy.
Virtual Health Coverage
Talk with a primary care provider virtually for routine wellness visits, preventive care and chronic care. Get unlimited visits at no additional cost. For questions and enrollment, call (800) 400-6354.
OTC Benefit
Our plan gives you a benefit of up to $95 a quarter. It allows you to purchase over-the-counter (OTC) products at participating retailers nationwide and online from a catalog with hundreds of products to choose from.
Helpful Terms
Copayment/coinsurance: The set dollar amount or percentage you pay for a doctor’s visit, at the hospital or at the pharmacy. Copayment is a fixed dollar amount (like $20), and coinsurance is a percentage (like 20%).
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups:
• Tier 1 (Preferred Generic).
• Tier 2 (Generic).
• Tier 3 (Preferred Brand).
• Tier 4 (Nonpreferred Drug).
• Tier 5 (Specialty Tier).
Generally, the higher the tier, the more you pay for the drug. Some prescriptions require step therapy (for you to try a lower tier first), prior authorization or a limit on the amount you can receive at one time. If your drug isn’t covered, you can ask for an exception. For more information, see the formulary.
Emergency care: This is the care you receive at an emergency room (ER) or emergency department. When you believe your health is at serious risk, seek emergency department care immediately. Don’t hesitate to call 911 for assistance.
Ground ambulance: What you pay for an ambulance ride in an emergency.
Inpatient hospital care: The amount you pay for a stay in an in-network hospital.*
Lab: What you pay for lab services, like blood tests.
Medical deductible: A set amount you pay before your plan starts helping pay for your medical care or pharmacy benefits. Our plans don’t have medical deductibles.
Outpatient care: Medical care or treatment that doesn’t include staying overnight in a hospital.
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Premium: The amount you pay each month for plan coverage. You must continue to pay your Medicare Part B premium.
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.*
Skilled nursing facility (SNF): What you pay for an approved stay at an SNF.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
Urgent care: The amount you pay for urgent or convenient care.
Yearly limit: The most you’ll pay in a coverage period before your plan pays 100% of covered expenses. It’s also called the out-of-pocket maximum.
* Review the provider directory at FirstMedicare.com for our in-network doctors and hospitals.
With both POS and PPO, you have the freedom to go out of network. But you likely save money by staying in network.
FirstCarolinaCare Insurance Company’s plans are HMO and PPO plans with a Medicare contract. Enrollment in a FirstCarolinaCare plan depends on contract renewal. You must continue to pay your Medicare Part B premium. Out-of-network/non-contracted providers are under no obligation to treat FirstCarolinaCare members, except in emergency situations. For accommodations of persons with special needs at meetings call (877) 749-3356 (TTY: 711), 8 a.m. to 8 p.m. local time. Voicemail used on holidays and weekends, April 1 through September 30. Other pharmacies/physicians/providers are available in our network. This information is not a complete description of benefits. Call (844) 499-5630 (TTY: 711) for more information.