The short answer
Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare offered by private insurance companies approved by Medicare. It covers everything Parts A and B cover, usually includes Part D drug coverage, and may add extras like dental, vision or hearing. Plans have provider networks and a yearly limit on out-of-pocket costs.
Written by Alan Roy, independent licensed insurance agent (FL #W937474) · Updated
What is Medicare Advantage?
Medicare Advantage plans, also called Part C, are offered by private insurance companies that contract with Medicare. Instead of using your red, white and blue card for hospital and doctor care, you use your plan's card, and the plan pays your covered costs.
Every Medicare Advantage plan must cover the same hospital (Part A) and medical (Part B) services as Original Medicare. Most plans also include Part D prescription drug coverage in the same plan.
What do Medicare Advantage plans cover?
- Hospital stays, skilled nursing and hospice (Part A services)
- Doctor visits, outpatient care, lab work and preventive care (Part B services)
- Prescription drugs, on most plans (Part D)
- Extra benefits on some plans, such as routine dental, vision, hearing or fitness programs. These vary by plan and county.
- A yearly maximum on what you pay out of pocket for covered in-network care
HMO vs. PPO: what's the difference?
HMO plans generally ask you to use doctors and hospitals in the plan's network and to choose a primary care doctor, and they may require referrals to see specialists. PPO plans let you see out-of-network providers, usually at a higher cost.
Because networks are local, the most important question is often simple: are your doctors, hospital and pharmacy in the plan's network here in Manatee, Sarasota or Hillsborough County?
What does Medicare Advantage cost?
You keep paying your Part B premium. Some plans also charge their own monthly premium, and you'll have copays or coinsurance when you get care. Costs, networks and extra benefits change every year, which is why reviewing your plan each fall matters.
When can I enroll in or change a Medicare Advantage plan?
- Your Initial Enrollment Period: the 7 months around your 65th birthday
- Annual Open Enrollment: October 15 – December 7, with coverage starting January 1
- Medicare Advantage Open Enrollment: January 1 – March 31, for people already in a Medicare Advantage plan
- Special Enrollment Periods: for example, after a move out of your plan's service area
Who it may fit
- You want one plan and one card for medical and drug coverage
- You're comfortable using a local network of doctors and hospitals
- Extra benefits such as dental or vision matter to you
- You want a yearly cap on your out-of-pocket medical costs
How Alan helps
- Checks that your doctors, hospital and pharmacy are in network before you enroll
- Compares the plans he offers in your county side by side, including drug costs
- Explains networks, copays and out-of-pocket limits in plain English
- Reviews your plan with you every fall so it still fits next year
Frequently asked questions
Is Medicare Advantage the same as a Medicare Supplement?
No. Medicare Advantage replaces how you receive your Original Medicare benefits. A Medicare Supplement (Medigap) works alongside Original Medicare to help pay your share of costs. You can't use both at the same time.
Do I still pay my Part B premium with Medicare Advantage?
Yes. You continue to pay your Part B premium, plus any premium your Medicare Advantage plan charges.
What happens if I travel or spend part of the year up north?
Many Medicare Advantage plans only cover emergency and urgent care outside their service area. If you split time between two states, ask about travel coverage before you choose a plan.
Does it cost anything to work with Alan?
No. Alan's help is free to you. As an independent agent, he's paid by the insurance companies he represents.
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This page is general educational information about Medicare and is not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability, benefits and costs vary by plan and county. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.