What Is a Medicare Advantage Plan?

Medicare Advantage, also known as Medicare Part C, is a bundled alternative to Original Medicare. Private insurers that offer Medicare Advantage plans contract with the federal government to provide health insurance benefits to people who qualify for Medicare.

About half of people eligible for Medicare are in Medicare Advantage plans^[0]

Pros and cons of Medicare Advantage plans (Medicare Part C)

Medicare Advantage plans have benefits and drawbacks. While they're a slam-dunk choice for some people, they're not right for everyone.

Pros:

• Extra benefits: Medicare Advantage plans may include extra benefits like some hearing, dental and vision coverage, which aren't covered by Original Medicare^[0]

  Centers for Medicare & Medicaid Services. Understanding Medicare Advantage Plans. Accessed Sep 6, 2023.

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• Lower costs: Many Medicare Advantage plans have no monthly premiums, and out-of-pocket costs may be lower than those for Original Medicare.

• Spending caps: There may be limits on how much you may pay out of pocket for hospital and medical coverage. This limit is determined by the Centers for Medicare & Medicaid Services, and it can be as high as $8,300 in 2023 ($8,850 in 2024).

• Drug coverage: Most people in Medicare Advantage plans have prescription drug coverage as part of the plan.

• All-in-one care: You can get your hospital, medical and drug benefits through one insurance company, which can feel simpler than the structure of Original Medicare.

Cons:

• Provider choice: With Medicare Advantage, you have less freedom to choose your medical providers because you often must use providers within your plan's network.

• Travel restrictions: Many plans require that you reside and get your nonemergency medical care in the plan’s geographic service area.

• Less plan flexibility: If you have Medicare Advantage, there may be limits on your ability to switch back to Original Medicare with a Medicare Supplement Insurance, or Medigap, policy.

• Prior authorization requirements: You may have to get approval from your Medicare Advantage plan to have certain tests or procedures, which can delay care.

• Plan restrictions: You may have to get a referral from your primary care physician each time you see a specialist, unlike Original Medicare.

• Potential for instability: There's a chance your Medicare Advantage plan could end coverage, either by the insurer or the network and its included medical providers. (If this happens, you’ll be notified and offered other options.)

How Medicare Advantage plans work

Medicare Advantage plans are required to provide the same benefits as Medicare Part A, which covers hospitalization, and Medicare Part B, which covers doctor’s visits^[0]

» MORE: Medicare vs. Medicare Advantage: Which should I choose?

How to choose the best Medicare Advantage plan

Comparing Medicare Advantage plans requires you to understand your health care needs and think about what each type of plan offers. If you have a chronic health condition and want to be able to keep using a specific doctor or facility, you’ll want health coverage that they accept. If you take prescription drugs, some plans may offer lower out-of-pocket costs than others.

Here are some questions to ask as you evaluate Medicare Advantage plans:

• Do you have to get a referral to see specialists?

• What benefits does each plan include? (Do you need vision or dental, and if so, are they included?)

• Are all of your prescription drugs covered, and how much will they cost?

• Are your doctors included in the network?

• What’s the plan's Medicare star rating?

• What are the plan's deductibles, coinsurance and copays?

• What's the plan's out-of-pocket maximum?

How to enroll in a Medicare Advantage plan

Once you’ve done your research and found a Medicare Advantage plan that fits your needs, there are various ways to enroll, according to Medicare.gov:

• Use Medicare’s plan finding tool to find the plan in your area. Enter your ZIP code to get started.

• Go to the plan’s website, and look for an option to enroll online.

• Contact the plan to get an enrollment form, which you can complete and return.

• Call the plan and join by phone.

• Call Medicare at 800-MEDICARE (800-633-4227).

You will need your Medicare number and the date your Medicare Part A and/or Part B coverage started. You must be enrolled in Medicare Parts A and B before you can buy a Medicare Advantage plan.

You can enroll in a Medicare Advantage plan only during your initial enrollment period (when you first become eligible for Medicare) or during the open enrollment period from Oct. 15 to Dec. 7. Once you have a Medicare Advantage plan, you can switch plans during Medicare open enrollment in the fall or Medicare Advantage open enrollment from Jan. 1 to March 31 each year^[0]

» MORE: Medigap vs. Medicare Advantage: What's the difference?

How to switch Medicare Advantage plans

If you want to change Medicare Advantage plans, you can do so during Medicare's fall open enrollment period (Oct. 15 to Dec. 7) or Medicare Advantage's open enrollment period (Jan. 1 to March 31).

You also can change to Original Medicare during these periods, but it may be hard to get a Medicare Supplement Insurance policy if you switch after the first year. In most states, insurers are required to issue you a Medigap policy only during your initial Medigap enrollment period (typically the six months after you turn 65 and enroll in Medicare Part B) or if you switch out of your Medicare Advantage plan in the first year. After that, insurers may deny you a Medigap policy if you have health problems, or they can require a waiting period before your pre-existing conditions are covered^[0]