Frequently Asked Questions

What is a Medicare Advantage plan?

Medicare Advantage, or Part C, is a type of Medicare plan offered by private insurance companies. It includes all the coverage of Original Medicare and often provides additional benefits like dental, vision, hearing, and prescription drugs.  Plans can be as low as $0 monthly.  Pay for medical as they come up with co-pays or coinsurance and a network of providers.

What does Medicare Advantage cover?

These plans cover hospital and medical care (Parts A & B) and usually include drug coverage. Many also include extras like gym memberships, over-the-counter benefits, dental, and vision products.

How is Medicare Advantage different from Original Medicare?

Original Medicare is administered by the government and offers nationwide provider access. Medicare Advantage is managed by private companies and may have local provider networks and plan-specific rules.  Medicare Advantage plans "replace" Medicare to become your primary provider.  You never actually lose Medicare but while on a Medicare Advantage plan - the plan becomes the primary coverage and not Medicare.

Do Medicare Advantage plans have networks?

Yes. Plans often use HMO or PPO networks. With an HMO, you typically need referrals (many do not require referrals now) and must use in-network providers. PPOs offer more flexibility but may have higher costs for out-of-network care. 

Can I switch from Original Medicare to Medicare Advantage?

Yes. You can make the switch during the Annual Enrollment Period (Oct 15 – Dec 7). You may also qualify for a Special Enrollment Period due to changes in your circumstances such as losing employer coverage.

Are prescription drugs included in Medicare Advantage?

Most plans include drug coverage, but not all. It’s important to review each plan’s formulary to make sure your medications are covered.

How much does a Medicare Advantage plan cost?

Many plans have low or $0 premiums. However, you’ll still be responsible for the Medicare Part B premium and any plan-specific costs like copays, coinsurance, and deductibles.

How do I compare Medicare Advantage plans near me?

Compare plans by ZIP code online or talk to a licensed local Medicare insurance agent who can help you understand the differences in coverage, networks, and benefits in your area.