Medicare Advantage

Medicare Advantage Plans, sometimes called "Part C", are a privatized alternative to Original Medicare (opens in new tab). Medicare Advantage combines everything you get in Part A (opens in new tab) (hospital insurance) and Part B (opens in new tab) (medical insurance), usually with added benefits, like prescription drug coverage (Part D), dental, vision, and wellness perks. If you join a Medicare Advantage Plan, you still have Medicare, but the Medicare Advantage plan is your primary insurer.

Cost

Many Medicare Advantage plans offer $0 or low monthly premiums, These amounts will vary by plan and by geographic location, so be sure to check the specific plans available in your area.

Medicare Advantage plans usually have set dollar amounts for most services and procedures, rather than coinsurance (opens in new tab), which is a percentage of the overall bill. These set dollar amounts can give Medicare Advantage members an opportunity to plan ahead because they can anticipate the costs of upcoming services and procedures.

Maximum out-of-pocket limit

Most Medicare Advantage plans have a maximum out-of-pocket limit (MOOP). A MOOP is the most money you’ll pay for covered health care in a calendar year, aside from any monthly premium. Once you’ve reached this amount for the year, your insurance company pays for 100% of covered services. For a deeper dive into how a MOOP works, you can read our post, What’s a Medicare Advantage MOOP (opens in new tab)?

Coverage

Some Medicare Advantage plans require you to see a doctor or facility in their network. When in doubt, ask your doctor what Medicare Advantage plans they accept.

Most Medicare Advantage plans include prescription coverage, while Original Medicare requires members to buy a separate Part D prescription plan.

Supplemental benefits

Some Medicare Advantage plans include dental, vision, and hearing, as well as perks like gym memberships and home delivery for prescriptions. Other extra benefits can include hearing aids and an allowance for over-the-counter items like pain relievers and personal care products.

You can read more on the value of supplemental benefits (opens in new tab) on our blog.

How to enroll

To enroll in a Medicare Advantage plan, a person must have Part A and Part B and live in the Medicare Advantage plan’s service area. Individuals can first enroll into a plan during the seven month period that begins three months before and ends three months after their 65th birthday. Medicare beneficiaries can also make changes to their plan during the Annual Enrollment Period (AEP) (opens in new tab), which happens every year from October 15th to December 7th. If you make a change during this period, the new plan becomes effective on January 1st of the upcoming year.