Medicare Advantage, also known as Medicare Part C, is a health insurance program offered by private companies that contract with Medicare. It provides an alternative way for Medicare beneficiaries to receive Medicare benefits. Medicare Advantage plans often include additional benefits beyond what Original Medicare (Part A and Part B) offers, such as prescription drug coverage, vision, dental, and wellness programs.

These plans typically have networks of doctors and hospitals participants must use to receive the full benefits. Medicare Advantage plans are required to cover all the same services as Original Medicare. However, plans may have different costs and restrictions, like requiring prior authorization before covering an outpatient surgery, for example. 

How does Medicare Advantage work?

Medicare Advantage works by providing similar coverage as Original Medicare (Part A Hospital and Part B Medical), often with additional benefits and services provided by private insurance companies.
Here’s how Medicare Advantage generally works:
  1. Enrollment: To be eligible for a Medicare Advantage plan, you must first be enrolled in You can then enroll in a Medicare Advantage plan during specific enrollment periods.
  2. Plan Selection: There are different types of Medicare Advantage plans, such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), and Special Needs Plans (SNPs). You can choose a plan that suits your healthcare needs and preferences.
""
  1. Coverage and Benefits: Medicare Advantage plans provide coverage for all Medicare-covered services, including hospital stays, doctor visits, and medical procedures. Many plans may offer extra benefits such as prescription drug coverage, dental and vision care, hearing aids, and fitness programs.
  1. Provider Networks: : Medicare Advantage plans typically have a network of healthcare providers, including doctors, hospitals, and specialists.

You may need to choose a primary care physician (PCP) and get referrals to see specialists within the network. Some plans may also offer out-of-network coverage, but it can be more expensive.

  1. Costs: Medicare Advantage plans have premiums, deductibles, and copayments that vary depending on the plan. It’s important to review and compare the costs of different plans to understand your out-of-pocket expenses.
  2. Medicare Advantage vs. Original MedicareIf you choose to enroll in a Medicare Advantage plan, you will still be enrolled in Medicare, but your Medicare benefits will be administered by the private insurance company offering the plan. Take a look at this helpful chart comparing Original Medicare to Medicare Advantage. You must continue to pay your Medicare Part B premium, along with any additional premium (if any) required by the Medicare Advantage plan.

    Before deciding on a plan, it’s important to carefully review the details of each Medicare Advantage plan to understand its coverage, costs, and network limitations.

How much does a Medicare Advantage plan cost?

The cost of a Medicare Advantage plan can vary depending on several factors, including the specific plan you choose, your location, and the coverage options it offers. Here are some common costs associated with Medicare Advantage plans:

  1. Premiums: Medicare Advantage plans may have a monthly premium in addition to the Medicare Part B premium that you must continue to pay. However, some plans have $0 premiums, while others may have higher premiums for more comprehensive coverage.
  2. Deductibles: Some Medicare Advantage plans have an annual deductible that you must pay before the plan starts covering your healthcare costs. The deductible amount can vary between plans.
  3. Copayments/Coinsurance: Medicare Advantage plans typically require you to pay copayments or coinsurance for various healthcare services, such as doctor visits, hospital stays, and prescription drugs. These costs can vary depending on the specific service and plan.
  4. Out-of-Pocket Maximum: Medicare Advantage plans have an out-of-pocket maximum, which is the maximum amount you would have to pay for covered services each year. Once you reach this limit, the plan will cover all additional medical costs for the remainder of the year.
""

Always review and compare the costs of different Medicare Advantage plans available in your area to understand how they align with your healthcare needs and budget. Keep in mind that costs can change each year, so it’s essential to review your plan annually during the Medicare Open Enrollment Period (October 15 – December 7) to ensure it still meets your needs.

How and when can I enroll in a Medicare Advantage plan?

You can enroll in a Medicare Advantage plan during specific enrollment periods. Here are the different enrollment options available:
  1. Initial Enrollment Period (IEP): This is the seven-month period that begins three months before your 65th birthday month, includes your birthday month, and ends three months after your birthday month. During this period, you can enroll in a Medicare Advantage plan for the first time.
  2. Open Enrollment Period (OEP): The OEP takes place from October 15 to December 7 each year. During this period, you can enroll in a Medicare Advantage plan, switch from one Medicare Advantage plan to another, or switch from a Medicare Advantage plan back to Original Medicare.
  3. Medicare Advantage Open Enrollment Period (MA OEP): The MA OEP occurs January 1 to March 31 each year. During this time, if you are already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare with or without a standalone Medicare Part D prescription drug plan.
  4. Special Enrollment Periods (SEPs): SEPs are available for individuals who experience qualifying life events, such as moving out of the plan’s service area, losing other coverage, or becoming eligible for Medicaid. These events may allow you to enroll in or make changes to your Medicare Advantage plan outside of the standard enrollment periods.

    It’s important to note that the availability of specific Medicare Advantage plans can vary by location. To find out if you are eligible to enroll and explore Medicare Advantage plan options in your area, visit our website, enter your zip code, and fill out the form or schedule an appointment with an agent.

This blog is up to date as of March 2025 and has not been updated for changes in the law, administration or current events.

This information is general in nature and should not be considered financial, legal or tax advice. Consult an attorney or a tax professional regarding your specific situation.