MEDICARE ADVANTAGE
Medicare choices are local. Your plan should fit your doctors, prescriptions and priorities.
Medicare Advantage plans can differ by county, network, prescription coverage, cost sharing and supplemental benefits. The right comparison starts with the care you actually use — not the extras in the brochure.
What is Medicare Advantage?
Medicare Advantage, also called Part C, is offered by private insurance companies that contract with Medicare. Plans provide Part A and Part B benefits, and many include Part D prescription drug coverage and additional benefits.
What I check before comparing plans
- Your doctors and hospitals
- Your prescriptions and preferred pharmacy
- Specialist, imaging and inpatient costs
- Maximum out-of-pocket exposure
- HMO/PPO network rules
- Dental, vision, hearing and OTC details
- County availability and enrollment eligibility
Medicare Advantage vs Original Medicare
| Original Medicare | Medicare Advantage |
|---|---|
| Federal Part A and Part B coverage | Private plan administers Part A and Part B benefits |
| Broad provider access among providers accepting Medicare | Plan-specific network and service-area rules may apply |
| No built-in annual Part A/B out-of-pocket maximum | Plans include an annual maximum out-of-pocket for covered Part A/B services |
| Part D generally separate | Many plans include Part D |
What is a Part B giveback?
Some Medicare Advantage plans may reduce part of a member’s Part B premium. Availability and amount vary by plan and location. A giveback should be compared in the context of doctors, prescriptions, copays and the rest of the plan.
When can I enroll or change plans?
Different Medicare election periods and Special Enrollment Periods can apply depending on the person’s circumstances. Eligibility should be checked against current Medicare rules rather than assumed.
How should I compare plans?
Start with doctors, hospitals, prescriptions, pharmacy, expected medical use, travel needs and total potential cost. Supplemental benefits can matter, but they should not outweigh core medical and prescription fit.
Plan availability, benefits, networks, formularies, costs and enrollment rules change. Current Medicare and CMS-approved plan materials should be verified before enrollment.