Is Medicare Advantage the same as Original Medicare?

No, Medicare Advantage is another way to receive your Medicare Part A and Part B benefits. You remain enrolled in Medicare, but a private Medicare-approved insurance company administers your covered services through the Medicare Advantage plan. Private insurance companies offer Advantage plans that are required to provide at least the same benefits as Original Medicare, but the way you access care (networks, prior authorization, copays) is different and many plans include extras like dental and vision.

What's the difference between HMO and PPO Medicare Advantage plans?

HMO plans generally require you to use the plan's network for non-emergency care and may require referrals for certain services. PPO plans generally offer more flexibility to use out-of-network providers, although you may pay more when you do. Specific rules vary by plan.

Do Medicare Advantage plans cover dental and vision?

Some Medicare Advantage plans include additional benefits such as dental, vision, hearing, fitness, transportation, or over-the-counter allowances. These benefits vary by plan and location, so they should be reviewed along with provider networks, prescription coverage, and overall costs.

Can I switch Medicare Advantage plans?

Yes. You can change plans during the Annual Enrollment Period (October 15 to December 7) for coverage starting January 1. People already in a Medicare Advantage plan also get a one-time switch during the Medicare Advantage Open Enrollment Period (January 1 to March 31). Special Enrollment Periods may apply if you move, lose coverage, or qualify for Extra Help.

What happens if my doctor leaves the network mid-year?

If a doctor or hospital leaves your plan's network, your options depend on the type of plan and the circumstances. You may need to choose another in-network provider, use out-of-network benefits if your plan allows them, or review whether a different Medicare option better fits your needs during an eligible enrollment period.

Medicare Advantage Plans & Options

Q: Are all Medicare Advantage plans $0 premium?

No. Some Medicare Advantage plans have a $0 additional plan premium, while others charge a monthly premium. You must continue paying your Medicare Part B premium, and other costs such as deductibles, copayments, coinsurance, and prescription costs may still apply.

What is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is another way to receive your Medicare Part A and Part B benefits through a private insurance company approved by Medicare. You remain enrolled in Medicare, but the Medicare Advantage plan administers your covered medical benefits.

Many Medicare Advantage plans also include Part D prescription drug coverage, and some may offer additional benefits such as dental, vision, hearing, fitness, transportation, or over-the-counter allowances. Benefits vary by plan and location.

What Medicare Advantage plans may include

Part A and Part B covered services
Part D prescription drug coverage in many plans
An annual out-of-pocket maximum for covered Part A and Part B services
Additional benefits that may include dental, vision, hearing, fitness, transportation, or OTC benefits
Special benefits available through certain plan types or eligibility categories

How the costs work

Some Medicare Advantage plans have a $0 additional plan premium. You must continue paying your Medicare Part B premium, and other costs such as deductibles, copayments, coinsurance, and prescription costs can still apply.

When you use care, you typically pay copays or coinsurance for each service (a flat $20 for a primary care visit, $40 for a specialist, a percentage for a hospital stay, etc.). Each plan publishes its specific cost-sharing in a document called the Summary of Benefits.

The annual out-of-pocket maximum is one of the biggest differences from Original Medicare. Once your covered costs hit the maximum, the plan pays 100% of covered services for the rest of the year.

HMO, PPO, and other network types

Medicare Advantage plans use different network structures. The most common types:

HMO (Health Maintenance Organization): You generally use the plan's network for non-emergency care and may need a primary care provider or referrals for certain services, depending on the plan.
PPO (Preferred Provider Organization): PPO plans generally allow both in-network and out-of-network care, although you may pay more when using providers outside the network. Referral requirements vary by plan.
HMO-POS (Point of Service): An HMO that allows some out-of-network care for specific services.
PFFS (Private Fee-for-Service): You can see any provider that agrees to the plan's payment terms (less common).
SNP (Special Needs Plan): Plans designed for people with specific conditions, those with both Medicare and Medicaid (dual-eligibles), or those living in long-term care institutions.

Who may prefer Medicare Advantage

Medicare Advantage may appeal to people who:

Prefer having medical and often prescription coverage combined in one plan
Are comfortable using a plan's provider network
Want an annual limit on covered Part A and Part B out-of-pocket costs
Find additional plan benefits valuable
Have doctors, hospitals, and prescriptions that work well with plans available in their area

Original Medicare with a Medicare Supplement may be worth comparing if you:

Want broader provider access across the country
Travel frequently or live in more than one state
Prefer fewer network restrictions
Prefer a different balance between monthly premiums and medical cost sharing

In those situations, it may be helpful to compare Medicare Advantage with Original Medicare plus a Medicare Supplement. The right fit depends on your providers, travel needs, prescriptions, budget, and how you prefer to manage out-of-pocket costs.

How to enroll in a Medicare Advantage plan

You can join, switch, or drop a Medicare Advantage plan during specific enrollment windows:

Initial Enrollment Period: the 7-month window around your 65th birthday
Annual Enrollment Period (AEP), October 15 to December 7 each year, for coverage starting January 1
Medicare Advantage Open Enrollment Period, January 1 to March 31 each year, for people already in an Advantage plan
Special Enrollment Periods: triggered by qualifying life events such as moving, losing other coverage, or qualifying for Extra Help

To enroll, you need to have Medicare Parts A and B, and live in the plan's service area. A licensed agent can help you compare plans, see if your doctors and medications are covered, and walk you through the enrollment paperwork.

Compare Medicare Advantage Plans in Your Area