Medicare Advantage (Part C)

An all-in-one alternative to Original Medicare — often with extra benefits and low premiums. Here's how it works and what to watch for.

What Is Medicare Advantage?

Medicare Advantage, also known as Part C, is an all-in-one alternative to Original Medicare. It is offered by private insurance companies approved by Medicare. When you join a Medicare Advantage plan, you are still in the Medicare program, but you get your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Medicare Advantage plan, not Original Medicare.

How it Works: Unlike Original Medicare, where the government pays for your care directly, Medicare pays the private Medicare Advantage plan a set amount each month for your care. All plans have an annual MOOP (Maximum Out of Pocket) threshold. In exchange, these plans must follow rules set by Medicare and must provide all services that Original Medicare covers.

Costs: They generally have lower out-of-pocket costs and different copayment/coinsurance structures than Original Medicare. Only medically necessary services are authorized, so prior authorization is commonplace to manage costs.

Benefits: Most Medicare Advantage plans include Prescription Drug Coverage (Part D).

Extras: They often cover benefits that Original Medicare does not, such as fitness programs, and some vision, hearing, and dental services. Your costs for these extras do not count toward your Annual Maximum Out of Pocket threshold.

Types of Medicare Advantage Plans

HMO (Health Maintenance Organization)

Most Common

You must use doctors and hospitals in the plan's network (except in emergencies). You typically need a referral from your primary care doctor to see a specialist. Usually the lowest-cost option.

PPO (Preferred Provider Organization)

Most Flexible

You can see any doctor or specialist, in-network or out-of-network, without a referral. Out-of-network care costs more. More flexibility than an HMO.

HMO-POS (Point of Service)

A hybrid of HMO and PPO. You have a primary care doctor and network, but can go out-of-network for certain services at a higher cost.

PFFS (Private Fee-for-Service)

The plan sets its own payment rates. You can see any Medicare-approved provider who agrees to the plan's terms. Network restrictions vary.

SNP (Special Needs Plan)

Specialized

Designed for people with specific diseases, conditions, or characteristics — such as dual eligibility for Medicare and Medicaid, or chronic conditions like diabetes or heart failure.

MSA (Medical Savings Account)

Combines a high-deductible health plan with a bank account Medicare deposits money into. You use the account to pay for healthcare costs. Less common.

Medicare Advantage vs. Original Medicare

Advantages of Medicare Advantage

Often low monthly premium (beyond Part B)
Built-in Part D drug coverage in most plans
Extra benefits: dental, vision, hearing, fitness
Annual out-of-pocket maximum protects you from catastrophic costs
Care coordination through a primary care doctor

Things to Consider

Network restrictions — your doctors must be in-network
Prior authorization often required for procedures
Plans change annually — benefits, costs, and networks can shift
May not be accepted if you travel frequently or live in multiple states
Switching back to Original Medicare + Medicare Supplement/Medigap can be difficult after age 65

When Can You Enroll?

Initial Enrollment Period (IEP)

3 months before to 3 months after your 65th birthday

Annual Election Period (AEP)

October 15 – December 7 each year

Medicare Advantage Open Enrollment Period

January 1 – March 31 each year

Special Enrollment Period (SEP)

Triggered by qualifying life events

We do not offer every plan available in your area. Currently, we represent 10-12 organizations which offer 0-255 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.

Not Sure If Medicare Advantage Is Right for You?

We'll compare your options side by side — Medicare Advantage vs. Original Medicare with a Medicare Supplement/Medigap supplement — so you can make the most informed choice for your health and budget.