What Is a Medicare Advantage Plan?
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Medicare Advantage 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 four in 10 people eligible for Medicare are in Medicare Advantage plans.
The pros and cons of Medicare Advantage
Medicare Advantage plans have benefits and drawbacks. While they're a slam-dunk choice for some people, they're not right for everyone.
Pros:
Additional benefits, which may include some cost savings or subsidies toward hearing, dental and vision care.
Potentially lower premiums for coverage.
Limits on how much you may have to pay out of pocket for hospital and medical coverage. This limit is determined by the Centers for Medicare & Medicaid Services, and in 2022 it is $7,550.
Cons:
Less freedom to choose your medical providers.
Requirements that you reside and get your nonemergency medical care in the plan’s geographic service area.
Limits on your ability to switch back to Original Medicare with a Medicare Supplement Insurance policy.
The potential for the plan to end, either by the insurer or by 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 — also known as Medicare Part C — are required to provide the same benefits as Medicare Part A, which covers hospitalization, and Medicare Part B, which covers doctor’s visits. Medicare Advantage plans also typically include Medicare Part D prescription drug coverage and may include benefits not covered by Medicare, providing some savings on routine dental care, eye exams and glasses, and hearing aids.
Medicare Advantage vs. Original Medicare
Medicare Advantage plans may have provider networks that limit your choices. If you go outside the network, your care may not be covered or may cost significantly more than if you stay in-network. With Original Medicare, you generally can use any doctor or medical facility that accepts Medicare assignment.
In exchange for less freedom, though, you often pay less. You would still be required to pay a monthly premium for Part B, but the additional cost for a Medicare Advantage plan may be less than for a Medigap plan. Sometimes the Medicare Advantage plan may have a $0 premium.
Medicare Advantage plans may also have a maximum out-of-pocket limit for covered care. That caps the amount you’ll be expected to pay in addition to your premiums. In 2022, that cap is $7,550.
Medicare Advantage vs. Medigap
Medicare Advantage plans are sometimes confused with Medicare Supplement Insurance, also known as Medigap. Both are offered by private insurance companies, but the way your expenses are covered is different. As the name suggests, Medigap plans cover the “gaps” in Original Medicare by covering your share (generally 20%) of covered charges. When you seek medical care, most or all of your cost-share will be covered by your Medigap plan. For this, you'll pay a monthly premium.
Medicare Advantage plans, by contrast, are bundled plans that include the same coverage you'd get with Medicare Part A and Part B (and usually Part D), plus often limited coverage for other things, like some dental services or an allowance for some over-the-counter drugs. You may pay a premium for a Medicare Advantage plan, but many are offered at no premium beyond your required Medicare Part B premium. You’ll pay copays or coinsurance when you seek medical care. With a Medicare Advantage plan, you’ll pay out of pocket whenever you see a provider, and there’s an out-of-pocket limit of $7,550 on covered care in 2022.
Also, because Medigap policies are standardized, it’s relatively easy to compare costs. Every Medicare Advantage plan is different, so comparison shopping can be difficult. You can’t have both a Medicare Advantage plan and a Medigap plan at the same time.
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 covered?
What’s the plan's Medicare star rating?
Medicare Advantage providers
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
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:
Use Medicare’s plan finding tool to find the plan in your area. Click on “Enroll.”
Go to the plan’s website to see if you can enroll online. Contact the plan to get a paper enrollment form. Fill it out and return it to the plan provider.
Call the provider for the plan you wish to join.
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.
Keep in mind that you can only enroll in a Medicare Advantage plan 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’re enrolled in a Medicare Advantage plan, you can switch plans during Medicare Advantage Open Enrollment from Jan. 1 to March 31 each year.
How to switch Medicare Advantage plans
If you want to change Medicare Advantage plans, you can do so once a year, either during Medicare's fall open enrollment period (Oct. 15 to Dec. 7) or the Medicare Advantage open enrollment period (Jan. 1 to March 31).
You also can change to Original Medicare during these periods, but it could be hard to get a Medicare Supplemental Insurance policy if you switch after the first year. In most states, insurers are required to issue you Medigap policies 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 preexisting conditions are covered.
The parts of Medicare
Read more about the different parts of Medicare and what they cover.
