Medicare Advantage Explained
Another way to receive your Medicare benefits through a private insurance company approved by Medicare.
Part A + Part B
Medicare Advantage plans provide your covered hospital and medical benefits through the plan.
Prescription Drugs
Most Medicare Advantage plans include Part D prescription drug coverage.
Out-of-Pocket Limit
Medicare Advantage plans have a yearly limit on what you pay out of pocket for covered Part A and Part B services.
Additional Benefits
Some plans offer benefits Original Medicare doesn't cover, such as certain dental, vision, and hearing services.
The Important Part
Medicare Advantage plans are not all the same. Provider networks, prescription coverage, premiums, copays, benefits, prior authorization requirements, and out-of-pocket limits vary by plan. Comparing the specific plans available where you live is an important part of making your decision.
How Medicare Advantage Works
You still have Medicare, but you receive your Medicare-covered services through the Medicare Advantage plan you choose.
Medicare Part A + Part B
You must have both Part A and Part B to join a Medicare Advantage plan.
You Choose a Medicare Advantage Plan
Choose from Medicare Advantage plans available in your service area.
Your Plan Provides Your Coverage
The plan provides your Medicare-covered Part A and Part B services.
You Keep Medicare
You remain enrolled in Medicare Part A and Part B. You must continue paying your Medicare Part B premium in addition to any premium charged by your Medicare Advantage plan.
Your Plan Manages Your Coverage
You generally use your Medicare Advantage plan card when receiving covered healthcare services. The plan administers your Medicare-covered benefits.
Plan Rules Matter
Provider networks, referrals, prior authorization, prescription coverage, premiums, copays, and other benefits depend on the specific Medicare Advantage plan you choose.
One Important Distinction
Medicare Advantage does not supplement Original Medicare. It is another way to receive your Medicare Part A and Part B benefits. A Medicare Supplement, also called Medigap, works differently by helping pay certain costs left by Original Medicare.
HMO vs. PPO Medicare Advantage Plans
Medicare Advantage plans often use provider networks. Two common plan types are HMOs and PPOs. Understanding how they differ is important when choosing your coverage.
HMO
Health Maintenance Organization
More emphasis on using the plan's network
You generally receive your care from doctors, hospitals, and other providers in the plan's network.
Non-emergency care outside the network generally isn't covered, although some HMO Point-of-Service plans allow certain out-of-network services at a higher cost.
Many HMO plans require you to choose a primary care doctor.
In most cases, you need a referral to see a specialist. Certain services don't require one.
PPO
Preferred Provider Organization
More flexibility to use providers outside the network
PPO plans have a network of preferred doctors, hospitals, and other healthcare providers.
You generally have the option to receive covered services outside the plan's network, but you usually pay more.
PPO plans generally don't require you to choose a primary care doctor.
PPO plans generally don't require a referral to see a specialist.
Don't Choose a Plan by Premium Alone
Before enrolling, check whether your doctors, hospitals, specialists, and preferred healthcare systems participate in the plan's network. Also consider where you spend time or travel and how the plan handles care outside its service area.
Plan rules and benefits vary. Always review the specific plan's provider directory and Evidence of Coverage before making an enrollment decision.
What Does Medicare Advantage Cost?
Medicare Advantage costs vary by plan. Understanding premiums, copays, coinsurance, and out-of-pocket limits helps you compare more than the monthly premium.
Plan Premium
Some Medicare Advantage plans have a $0 monthly plan premium. Other plans charge an additional monthly premium.
Varies by planMedicare Part B Premium
$202.90Shown is the standard 2026 monthly Part B premium. You generally continue paying your Part B premium while enrolled in Medicare Advantage. Higher-income beneficiaries may pay more.
2026 Standard Part B PremiumCopays & Coinsurance
Your plan may charge copays or coinsurance when you receive healthcare services. What you pay depends on the specific plan and service.
Varies by planAnnual Out-of-Pocket Maximum
Medicare Advantage plans have a yearly limit on what you pay out of pocket for covered Medicare Part A and Part B services. The limit varies by plan.
Varies by plan$0 Premium Does Not Mean $0 Healthcare Costs
A $0 premium Medicare Advantage plan may still have deductibles, copays, coinsurance, prescription costs, and other out-of-pocket expenses. Look at your total potential healthcare costs, not only the monthly plan premium.
Look Beyond the Premium
Review the plan's doctors and hospitals, prescription coverage, copays, coinsurance, annual out-of-pocket limit, and additional benefits before choosing a Medicare Advantage plan.
What May Medicare Advantage Plans Include?
Medicare Advantage plans provide your Medicare Part A and Part B benefits. Many plans also include additional coverage or benefits. What is included depends on the specific plan.
Prescription Drug Coverage
Many Medicare Advantage plans include Part D prescription drug coverage within the same plan. Formularies, pharmacies, and drug costs vary by plan.
Dental Benefits
Some plans include dental benefits such as preventive care or other covered dental services. Coverage, provider networks, and benefit limits vary.
Vision Benefits
Some plans include routine vision benefits and allowances toward covered eyewear. Coverage and allowances depend on the plan.
Hearing Benefits
Some plans provide routine hearing benefits or assistance with covered hearing aids. Provider requirements and benefit limits vary.
Fitness & Wellness
Some plans offer fitness or wellness benefits. Participating locations, programs, and availability depend on the specific plan.
Other Plan Benefits
Depending on the plan and eligibility, additional benefits might include transportation, over-the-counter allowances, meals, or other supplemental benefits.
Benefits Are Not the Same on Every Plan
Do not choose a Medicare Advantage plan based only on additional benefits. First review your doctors, hospitals, prescriptions, pharmacies, healthcare costs, provider network, and plan rules. Then compare the additional benefits that matter to you.
What Should You Check Before Choosing a Medicare Advantage Plan?
Medicare Advantage plans vary. Before enrolling, look beyond the premium and review how the specific plan works for your healthcare needs.
Your Doctors & Hospitals
Check whether your doctors, specialists, hospitals, and preferred healthcare systems participate in the plan's network.
Your Prescriptions
Review the plan's formulary to see whether your medications are covered and what you may pay for them.
Your Pharmacies & Drug Costs
Check whether your preferred pharmacies participate in the plan's network and whether preferred pharmacies offer different costs.
Your Healthcare Costs
Review the premium, deductibles, copays, and coinsurance you may pay when you receive healthcare services.
Out-of-Pocket Maximum
Know the plan's annual out-of-pocket maximum for covered Medicare Part A and Part B services.
Prior Authorization & Referrals
Review which services require prior authorization and whether the plan requires referrals for specialist care.
Travel & Care Away From Home
If you travel or spend part of the year away from home, review the plan’s rules for routine, urgent, and emergency care outside its service area.
Additional Benefits
Compare dental, vision, hearing, fitness, and other supplemental benefits after reviewing your core healthcare coverage.
Compare the Whole Plan, Not One Benefit
A low premium or attractive extra benefit might get your attention. The better question is how the entire plan works for your doctors, prescriptions, healthcare needs, budget, and lifestyle.
You Don’t Have to Figure This Out on Your Own
Your Medicare decision is personal. We help you compare your options based on the things that matter most to you.
We’ll review the Medicare options available to you, answer your questions, and help you make an informed decision.
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