Medicare Advantage

What Is Medicare Advantage?

Medicare Advantage (also known as Part C) plans are provided by private insurers and essentially replace Original Medicare as your primary insurance. They cover all Medicare-covered benefits and may also provide additional benefits like some dental, hearing, vision and fitness coverage. Most of them also include Part D, which covers prescription drugs.

Your choice of doctors and hospitals is more restricted under Medicare Advantage, and you may be required to get different authorizations for care
Private insurers have the ability to manage your use of care in different ways, and this is the big tradeoff, compared to Original Medicare.

The average person on Medicare has over 30 Medicare Advantage plans to choose from, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service (PFFS) plans and special needs plans (SNPs). You’ll likely have a lot of choices to sort through, but not all types of plans are available in all areas.

Who Is Eligible for Medicare Advantage?

Generally, Medicare Advantage is available for:

Seniors age 65 or older
Younger people with disabilities
People with end-stage renal disease (permanent kidney failure requiring dialysis or transplant)

With Medicare Advantage plans, you must also be enrolled in Medicare Part A (hospital insurance) and Part B (Medicare insurance) and reside in the plan’s service area.

Enrollment only occurs during certain periods, but you cannot be denied coverage due to a preexisting condition. Specifically, you can join or switch to a Medicare Advantage plan with or without drug coverage during the following three windows:

Initial Medicare Enrollment Period: Begins three months before you turn 65 and ends three months after you turn 65
Annual Open Enrollment Period: From October 15 to December 7
Medicare Advantage Open Enrollment Period: January 1 to March 31 annually

The Benefits of Medicare Advantage

Medicare Advantage plans provide all the same benefits provided by Original Medicare, plus coverage for items and services not covered by Original Medicare, including some vision, some dental, hearing and wellness programs like gym memberships.

Some plans even provide transportation to doctor visits and adult day care services
Plans can also tailor their benefit packages to offer benefits to those who are chronically ill

Another bonus to consider is that coverage is expanding. According to a new report commissioned by the Better Medicare Alliance, the number of Medicare Advantage plans offering Special Supplemental Benefits for the Chronically Ill (known as SSBCI) rose from 245 plans in 2020 to 845 in 2021. Some of the top new non-medical benefits offered include:

Meals
Non-medical transportation
Resources addressing social needs
Pest control

Overall, Medicare Advantage plans offer convenient coverage options that are largely covered by a single insurer. There is also a sizable cost-saving opportunity

How Much Does a Medicare Advantage Plan Cost?

Many Medicare Advantage plans have a $0 premium, so be sure to explore your options.

If you enroll in a plan that does charge a premium, you must pay this fee every month in addition to your Medicare Part B premium
The monthly Part B premium for most people is $185 as of 2025.

Medicare Part B’s coinsurance and the deductible is $40, according to Medicare.gov, and once they are met, your copay under Medicare Advantage is typically 20% of the Medicare-approved amount for most services and products, such as durable medical equipment (DME) like glucometers, walkers, hospital beds and more.

Note: What gets many people into financial trouble is not following the rules of their plan, such as using an out-of-network provider or facility or getting products or services from a supplier not approved by Medicare.

To learn more about your costs in specific Medicare Advantage plans, contact the plan or visit Medicare.gov/plan-compare.