Medicare Advantage Plans
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What Is a Medicare Advantage Plan?
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies. Plans include Parts A and B, and many also include Part D prescription drug coverage and additional benefits.
Costs, benefits, provider networks, and coverage rules vary by plan.
Types & Features of Medicare Advantage Plans
Common plan types include HMO, PPO, Special Needs Plans (SNP), PFFS, and MSA plans. Depending on the plan, features may include:
- Hospital, medical, and prescription coverage in one plan
- Additional benefits not provided by Original Medicare
- Annual out-of-pocket limits
- Coordinated care through a provider network
Plan types and availability vary by location.
Choosing a Medicare Advantage Plan
The right plan depends on your healthcare needs and preferences. When comparing options, consider:
- Costs: Premiums and out-of-pocket expenses
- Providers: Whether your doctors are in-network
- Prescriptions: Drug coverage and preferred pharmacies
- Coverage: Benefits and services important to you
- Plan Rules: Referrals and prior authorization requirements
Enrolling in Medicare Advantage
You can enroll in or change Medicare Advantage coverage during certain periods, including:
- Initial Enrollment: Around the time you first become eligible for Medicare
- Annual Enrollment: October 15 – December 7
- Medicare Advantage Open Enrollment: January 1 – March 31 for current Medicare Advantage members
- Special Enrollment Periods: Available after certain qualifying life events
We can help you understand your enrollment options and compare plans available in your area.
Medicare Advantage Frequently Asked Questions
Can I switch from Original Medicare (with a Medigap plan) to Medicare Advantage (or vice versa)?
In some cases yes, but timing matters. Moving from Medigap (with Original Medicare) to an Advantage plan is usually easier than switching the other way (due to medical review, also called underwriting). For timing, see the enrollment section above.Are all Medicare Advantage plans the same?
No. Plans vary by state, county, and provider network. That’s why local guidance from professional advisors is key.Do Advantage plans include drug coverage?
Most do, but not all. You’ll want to verify if the plan includes Part D coverage, and if it doesn’t you may need to enroll (and pay) separately in a Medicare Part D plan. Some beneficiaries may choose an Advantage plan without Part D if they get prescription drug coverage from another entity (such as the VA for veterans).