Plans & Coverage
Medicare Advantage (Part C) Plans
Medicare Advantage (Part C) is an alternative to Original Medicare offered by Medicare-approved private insurers. Plans cover Part A and Part B services and often include Part D drug coverage. Networks, costs, and any extra benefits vary by plan and service area. The right fit depends on your doctors, prescriptions, care needs, and budget.
What's included
Medicare Advantage plans cover Part A and Part B services and may include Part D drug coverage. Some plans offer extra benefits, such as certain dental, vision, hearing, fitness, or other services; availability and coverage rules vary by plan. Each plan has a yearly limit for covered Part A and Part B services, which may have separate in- and out-of-network amounts.
HMO vs PPO
HMOs generally require you to use the plan's network for non-emergency care, and many require referrals for specialists; HMO-POS plans may allow some out-of-network services at higher cost. PPOs generally cover care from out-of-network providers at a higher cost and do not require specialist referrals. Exact rules vary by plan, so confirm your providers and benefits before enrolling.
Questions, answered
Is a $0 premium Medicare Advantage plan really free?
No. A $0 plan premium means no additional plan premium, but you still pay your Part B premium and may have copays, coinsurance, or a deductible. Each plan sets its own costs and yearly limit for covered Part A and Part B services; Part D drug costs are generally tracked separately.
Will my doctors be covered under Medicare Advantage?
It depends on the plan. HMOs generally use provider networks for non-emergency care; HMO-POS plans may cover some out-of-network care. PPOs generally cover out-of-network care at a higher cost. Rules vary, so confirm each provider and facility with the specific plan before enrolling.
What is the difference between Medicare Advantage and Original Medicare?
Original Medicare is federal Part A and Part B coverage; it generally lets you use any provider that accepts Medicare, and it has no yearly limit on your Part A and Part B out-of-pocket costs. Medicare Advantage plans are offered by private insurers and set plan-specific costs and provider rules; many use networks, and some include Part D or extra benefits.
Can I switch Medicare Advantage plans every year?
Often. During the Annual Enrollment Period (October 15–December 7), you can join, switch, or drop a Medicare Advantage plan for coverage starting January 1. If you are already enrolled in Medicare Advantage, you may also have one change during the Medicare Advantage Open Enrollment Period (January 1–March 31). Special Enrollment Periods may apply in certain situations. We can help check which window applies.
Do Medicare Advantage plans cover prescriptions?
Many Medicare Advantage plans include Part D drug coverage (MAPD plans), but not all. If a plan does not include drug coverage, you generally cannot add a separate Part D plan while staying in that Medicare Advantage plan; limited plan-type exceptions apply. Check the specific plan rules before enrolling. We can review its drug coverage and formulary.
What is the Medicare Advantage out-of-pocket maximum?
Medicare Advantage plans have a yearly limit on what you pay for covered Part A and Part B services. The limit is set by each plan and may differ for in-network and out-of-network services. After you reach the applicable limit, the plan pays 100% of covered services for the rest of the calendar year. Premiums, Part D drug costs, and services the plan does not cover generally do not count toward this limit.
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