Compare Medicare Advantage Plans and Coverage Options
Medicare Advantage, also called Medicare Part C, is another way to receive your Medicare Part A and Part B benefits through a Medicare-approved private insurance company.
Most Medicare Advantage plans include prescription drug coverage. Some plans may also offer benefits for dental, vision, hearing, fitness, and other health services.
Call (954) 872-1529Speak with a licensed insurance agent about Medicare Advantage plan options available in your area.
What Is a Medicare Advantage Plan?
Medicare Advantage plans are health plans offered by private insurance companies approved by Medicare. They provide your Medicare Part A hospital and Part B medical benefits instead of receiving those benefits directly through Original Medicare.
You must have Medicare Part A and Part B to join a Medicare Advantage plan. You also continue paying your Medicare Part B premium.
Plans must cover the medically necessary services covered by Original Medicare. Many plans also include prescription drug coverage and may provide additional benefits that Original Medicare does not normally cover.
What Can Medicare Advantage Include?
Benefits depend on the plan and where you live. Medicare Advantage plans combine Medicare coverage into one private health plan and may include additional services.
Hospital Coverage
Plans provide the Medicare Part A hospital benefits required by Medicare.
Medical Coverage
Plans provide Medicare Part B benefits for covered doctor, outpatient, preventive, and other medical services.
Prescription Drugs
Most Medicare Advantage plans include Medicare Part D prescription drug coverage.
Extra Benefits
Some plans offer additional dental, vision, hearing, fitness, or other health-related benefits.
Compare Common Medicare Advantage Plan Types
Medicare Advantage plans can organize doctor networks, referrals, costs, and coverage in different ways. Understanding the plan type can make comparison easier.
HMO Plans
Health Maintenance Organization plans generally use a network of doctors and hospitals. You normally receive routine care from network providers, except for emergency or urgent care and certain other situations. Some HMO plans require referrals for specialists.
PPO Plans
Preferred Provider Organization plans give you access to a provider network while also allowing covered care from some out-of-network providers. Out-of-network care usually costs more. PPO plans commonly provide more flexibility when seeing specialists.
PFFS Plans
Private Fee-for-Service plans determine how much the plan pays for covered services and how much you pay. Provider participation rules vary, so confirm that a provider accepts the plan’s payment terms before receiving non-emergency care.
Special Needs Plans
Special Needs Plans serve people who meet specific eligibility requirements. Some plans focus on people with certain chronic conditions, people who have both Medicare and Medicaid, or people who receive certain levels of institutional care.
Some Plans Include Benefits Beyond Original Medicare
Medicare Advantage plans may include additional benefits. The exact services, limits, provider networks, and costs vary by plan and location.
What Can You Pay With a Medicare Advantage Plan?
Medicare Advantage costs vary by plan. Review the complete cost structure instead of looking at only one number.
Plan Premium
Monthly Medicare Advantage premiums vary by plan and service area.
Part B Premium
You continue paying your Medicare Part B premium while enrolled in Medicare Advantage.
Cost Sharing
Deductibles, copays, and coinsurance depend on the plan and service you receive.
Annual Limit
Medicare Advantage plans include a yearly limit on what you pay for covered Part A and Part B health services.
What Should You Compare Before Choosing a Plan?
The lowest premium does not always mean the lowest total cost. Review the parts of the plan that affect the care and prescriptions you actually use.
Doctors and Hospitals
Check whether your doctors, specialists, hospitals, and other providers participate in the plan.
Prescription Drugs
Review your prescriptions, the plan drug list, pharmacy network, and expected drug costs.
Health Care Costs
Compare premiums, deductibles, copays, coinsurance, and the yearly out-of-pocket limit.
Additional Benefits
Review the services included, benefit limits, provider rules, and how often each benefit can be used.
Original Medicare and Medicare Advantage Work Differently
Original Medicare
Original Medicare includes Part A and Part B and is administered by the federal Medicare program.
You can generally use any doctor or hospital in the United States that accepts Medicare.
You can add a separate Part D drug plan and may also buy Medicare Supplement Insurance if you meet the applicable requirements.
Medicare Advantage
Medicare Advantage provides Part A and Part B benefits through a Medicare-approved private insurance company.
Plans often use provider networks and may have rules for referrals or prior approval for certain services.
Most plans include Part D drug coverage and some plans offer additional benefits not normally included with Original Medicare.
Who May Want to Review Medicare Advantage Options?
New to Medicare
People who recently became eligible for Medicare and want to understand their coverage choices.
Current Plan Members
Medicare beneficiaries who want to review changes in costs, doctors, prescriptions, or benefits.
People Comparing Costs
People who want to compare premiums, copays, drug costs, and annual out-of-pocket limits.
People Reviewing Benefits
People who want to review health coverage together with available drug and additional benefits.
When Can You Join or Change a Medicare Advantage Plan?
Medicare limits when you can join, change, or leave a Medicare Advantage plan. The enrollment period available to you depends on your situation.
Initial Enrollment
When you first become eligible for Medicare, you may have an opportunity to join a Medicare Advantage plan.
October 15 to December 7
During Medicare Open Enrollment, eligible people can join, switch, or leave a Medicare Advantage plan for coverage beginning January 1.
January 1 to March 31
People already enrolled in Medicare Advantage can generally make one plan change or return to Original Medicare during this period.
Special Enrollment Periods
Certain events, such as moving, losing other coverage, or changes involving Medicaid or Extra Help, may create another enrollment opportunity.
Have Questions About Medicare Advantage?
A licensed insurance agent can help you review plan types, provider networks, prescription coverage, costs, and available benefits in your area.
Call (954) 872-1529There is no obligation to enroll.
Medicare Advantage Questions
Is Medicare Advantage the same as Medicare Part C?
Yes. Medicare Advantage is also called Medicare Part C. Medicare-approved private insurance companies offer these plans as another way to receive Medicare Part A and Part B benefits.
Do Medicare Advantage plans include prescription drug coverage?
Most Medicare Advantage plans include Medicare Part D prescription drug coverage. Always review the specific plan because drug coverage and covered prescriptions vary.
Do Medicare Advantage plans include dental, vision, or hearing benefits?
Some Medicare Advantage plans provide benefits for services such as routine dental, vision, or hearing care. Benefit amounts, provider rules, and availability depend on the plan.
Can I keep my doctor with Medicare Advantage?
Provider access depends on the plan. Check each doctor’s current participation in the plan network before enrolling and review the network again each year.
Do I still pay my Medicare Part B premium?
Yes. You must continue paying your Medicare Part B premium while enrolled in a Medicare Advantage plan.
Does Medicare Advantage have an out-of-pocket limit?
Medicare Advantage plans have a yearly limit on what you pay for covered Part A and Part B health services. The amount varies by plan.
Are Medicare Advantage plans the same everywhere?
No. Available plans, provider networks, premiums, costs, drug coverage, and additional benefits vary by service area and insurance company.
Review Medicare Advantage Options With a Licensed Insurance Agent
Review available plan types, doctors, prescriptions, costs, benefits, and eligibility before making a Medicare coverage decision.
Call (954) 872-1529