What Is a Medicare Advantage Plan?

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

How does Medicare Advantage 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]

Advantages and disadvantages of Medicare Advantage plans

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

Pros:

• Extra benefits: Medicare Advantage plans typically 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 Jul 30, 2024.

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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 $8,850 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 generally must use providers within your plan's network.

• Travel restrictions: Many plans require that you live 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.)

Medicare Advantage by state

Medicare Advantage plan availability varies by location. Click on a state on the map below to see the best Medicare Advantage plans available in that state.

How to choose a 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 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 sign up for Medicare Advantage

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.

If you’re new to Medicare, you can enroll in a Medicare Advantage plan during your initial enrollment period (when you first become eligible for Medicare), during a special enrollment period (if you qualify) or during Medicare’s general enrollment period from Jan. 1 to March 15 each year^[0]

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

How to change Medicare Advantage plans

If you want to switch 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]

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

What is the disadvantage of a Medicare Advantage plan?

With Medicare Advantage, you generally must use providers and hospitals in the plan’s network, and if you can get out-of-network care, it may cost more. You typically must live and get your health care in the plan’s geographic service area, which can make traveling tricky.

And if you have health issues, it may be hard for you to go back to Original Medicare with a Medigap plan because in most states you must medically qualify for Medigap after the first six-month open enrollment window.

Why do people choose Medicare Advantage over Medicare?

Most Medicare Advantage plans offer extra benefits that aren’t covered by Original Medicare, such as some coverage for dental, vision or hearing care. They frequently have $0 monthly premiums and usually include prescription drug coverage. Their bundled structure can also seem simpler than Original Medicare.