What it is
Medicare Advantage, sometimes called Medicare Part C, is an option where private insurance companies approved by Medicare offer plans that cover Medicare Part A (hospital) and Part B (medical) benefits. Many plans also include prescription drug coverage and may add extras such as dental, vision or hearing benefits. What is included differs by plan, carrier, county and year.
Most Medicare Advantage plans use a network of doctors, hospitals and other providers. Depending on the plan type, such as an HMO or PPO, you may need to use in-network providers, choose a primary care doctor, or get a referral or prior authorization for certain services. Cost-sharing, like copays and coinsurance, varies from plan to plan.
Medicare Advantage is one of two common paths for people with Medicare. The other is Original Medicare, often paired with a Medigap (Medicare Supplement) plan and a separate Part D drug plan. Neither path is right for everyone, and the better fit depends on a person's health, doctors, budget and preferences.
This page is educational only and is not insurance, legal, tax, medical or financial advice. 2A Benefit is not an insurer and does not sell policies. Licensed agents provide quotes.
How it’s traditionally been approached
Traditionally, people have compared Medicare Advantage plans by looking at a few core areas: whether their doctors and hospitals are in the network, whether their medications are on the plan's drug list, how the plan handles costs when care is needed, and which extra benefits matter to them. Many people also read the plan's summary of benefits and Evidence of Coverage.
Many people review their coverage each year during the annual enrollment period in the fall, because plans can change their networks, benefits, drug lists and costs from one year to the next. Other enrollment windows may apply in certain situations. For current rules and dates, Medicare.gov or a licensed agent is the place to confirm.
A fair comparison also includes Medigap. Medigap generally lets you see any provider that accepts Medicare and offers predictable cost-sharing, but it generally comes with higher premiums, may involve medical underwriting outside open enrollment or guaranteed-issue periods, and requires a separate Part D plan. Medicare Advantage often includes drug coverage and extra benefits, but has networks, may require prior authorization, and has varying cost-sharing. Medigap Plans C and F are only available to people who were eligible for Medicare before 1 January 2020.
How the right agent may help
The right independent agent may help you sort through the many plan choices in your area and explain how they differ in plain English. A conversation often starts with your doctors, prescriptions, preferred pharmacies and any care you expect to need, so options can be viewed through the lens of your real life.
A review is generally a conversation, not a commitment. You might be asked about your current coverage, how you use care, and what matters most to you, such as travel, flexibility or extra benefits. Good questions to ask include: Are my doctors and hospitals in the network? Is each of my medications covered? What requires prior authorization? What happens if I need care outside my service area? Which carriers do you represent?
Agents must be licensed in each state where they sell, and Medicare plans are sold by agents appointed with each carrier. Confirm an agent's license with your state insurance department, and ask whether they represent a limited or broad set of carriers. A helpful agent may also compare Medicare Advantage with Original Medicare and Medigap so you can see the full picture. No agent can promise acceptance, savings or that a plan is the best one.
The bigger picture
Choosing health benefits plans can carry real weight. Worries about doctors, medications and unexpected bills can affect sleep, stress and peace of mind, while a clear understanding of your options may help you feel more settled and prepared. Taking time to review coverage each year can be one way of caring for your overall wellbeing.
Health is more than paperwork, and the best choice often reflects your whole life: your routines, relationships, finances and the care teams you trust. If you are also looking for care providers, Providers.plus may be a helpful place to explore. Every approach has its place, and the goal is a decision that feels right for you.
Keep in mind
- 2A Benefit is an independent, privately run directory, not connected with or endorsed by the U.S. government, the federal Medicare program, CMS, Medicare.gov, HealthCare.gov or any government agency.
- Plan details, networks, costs and benefits vary by carrier, county, state and year, so always confirm specifics directly with the plan or a licensed agent.
- This page is educational only, not insurance, legal, tax, medical or financial advice, and 2A Benefit does not sell policies or guarantee acceptance or savings.
- Verify any agent's license with your state insurance department, and check Medicare.gov for current rules and enrollment dates.
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Frequently asked questions
What is Medicare Advantage?
Medicare Advantage is a way to get your Medicare Part A and Part B benefits through a private insurance plan approved by Medicare. Many plans also include drug coverage and extras like dental or vision. Plans usually use networks and vary by area and year.
How do I compare Medicare Advantage plans?
People commonly compare whether their doctors and hospitals are in the network, whether their medications are covered, how cost-sharing works, and which extra benefits are included. Reading each plan's summary of benefits and Evidence of Coverage helps. A licensed agent may help you line up options side by side.
When is Medicare open enrollment for Medicare Advantage?
The annual enrollment period for Medicare plans takes place each fall, and it is when many people review or change their Medicare Advantage coverage. Other enrollment periods may apply in certain situations. Check Medicare.gov or a licensed agent for current dates and rules.
What is the difference between Medicare Advantage and Medigap?
Medigap works alongside Original Medicare, generally allows you to see any provider that accepts Medicare, and offers predictable cost-sharing, but it generally has higher premiums, may involve medical underwriting outside open enrollment or guaranteed-issue periods, and needs a separate Part D plan. Medicare Advantage often includes drug coverage and extra benefits, but has networks, possible prior authorization and varying cost-sharing. Medigap Plans C and F are only for those eligible before 1 January 2020.
Can a Medicare Advantage plan change every year?
Yes, Medicare Advantage plans can change their benefits, costs, networks and drug lists from year to year. That is why many people review their plan each fall. Reading your plan's annual notice and comparing options may help you spot changes that affect you.
How do I know a Medicare agent is licensed?
Contact your state insurance department to confirm an agent's license, since agents must be licensed in each state where they sell. Medicare plans are also sold by agents appointed with each carrier, so ask which carriers they represent. 2A Benefit is a directory and does not sell policies.
Educational resource. 2A Benefit shares general information and connects people with independent agents. It is not professional advice. Talk with a qualified professional about your own situation.