Understanding Medicare Advantage Plans

Understanding Medicare Advantage Plans

Comprehensive healthcare coverage that goes beyond Original Medicare

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What is a Medicare Advantage Plan?

Medicare Advantage (Part C) is a type of Medicare health plan offered by private insurance companies that contract with Medicare. These plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits, and often include prescription drug coverage (Part D) and additional benefits not covered by Original Medicare.

Medicare Advantage plans are an all-in-one alternative to Original Medicare, offering the same coverage plus more, often with lower out-of-pocket costs and added convenience.

Key Benefits of Medicare Advantage

All-in-One Coverage

Combines hospital, medical, and often prescription drug coverage into a single plan, simplifying your healthcare management.

Extra Benefits

Many plans include dental, vision, hearing, and fitness benefits that aren't covered by Original Medicare.

Out-of-Pocket Maximum

Annual limit on your healthcare expenses provides financial protection against catastrophic medical costs.

Coordinated Care

Many plans offer care coordination services to help manage your health conditions and medications.

Lower Costs

Often features lower premiums and copays compared to Original Medicare with a Medigap policy.

Wellness Programs

Access to health and wellness programs, including gym memberships and healthy living incentives.

How Medicare Advantage Works

1

Enrollment

You must have Medicare Part A and Part B to enroll in a Medicare Advantage plan during specific enrollment periods.

2

Choose Your Plan

Select a plan that fits your healthcare needs, budget, and includes your preferred doctors and hospitals.

3

Use Your Benefits

Visit in-network providers and use your plan's benefits for medical care, prescriptions, and additional services.

4

Pay Your Costs

Pay your monthly premium (if any) and copays or coinsurance when you receive covered services.

Medicare Advantage vs. Original Medicare

Medicare Advantage

Hospital Coverage (Part A)
Included
Medical Coverage (Part B)
Included
Prescription Drug Coverage
Usually Included
Out-of-Pocket Maximum
Yes
Extra Benefits (Dental, Vision)
Often Included
Network Restrictions
Yes (HMO/PPO)
Referrals Required
Sometimes (HMO)

Original Medicare

Hospital Coverage (Part A)
Included
Medical Coverage (Part B)
Included
Prescription Drug Coverage
Must add Part D
Out-of-Pocket Maximum
No limit
Extra Benefits (Dental, Vision)
Not covered
Network Restrictions
Any Medicare provider
Referrals Required
No

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© 2025 Medicare Advantage Information. For educational purposes only. This is not a complete list of plans or benefits. Please contact Medicare.gov or 1-800-MEDICARE for more information.