All About Medicare Advantage

During your search for your right coverage, you may have come across Medicare Advantage. Otherwise known as “Medicare Part C,” these plans are a bundled alternative to Original Medicare that often include extra benefits.

Medicare Advantage vs. Original Medicare

Coverage

Offered by private companies, Medicare Advantage plans provide similar coverage to Original Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). They often also include Part D prescription drug coverage, as well as added benefits.

Costs

Unlike Original Medicare, Medicare Advantage plans put a firm limit on your out-of-pocket medical costs that’s determined each year by CMS, the government agency that oversees Medicare. The limit for 2025 is $9,350 — that’s the most you would pay out-of-pocket this year if you were enrolled in a Medicare Advantage plan.

Medicare Advantage costs vary by plan. When you enroll in a plan, you must continue to pay your Medicare Part B premium. In addition to that, some plans have a premium that you pay to the insurance company each month.

Other variable costs include whether the plan has a yearly deductible — the amount you must pay for covered services before your plan begins to pay — and the plan’s copay and/or coinsurance costs. These costs can change each year. That’s why it’s important to carefully compare and review plans to make sure your plan fits your budget.

Doctors and hospitals

One of the key differences between Medicare Advantage and Original Medicare is your choice of doctors and hospitals. Original Medicare usually provides coverage for any doctor or provider that accepts Medicare throughout the United States. With Part A and Part B, you likely won’t need a referral to see a specialist, but you may need a referral if you have Medicare Advantage.

Medicare Advantage plans typically include a network of participating doctors and hospitals. If you use a provider that’s not in your plan’s network or service area, you may have to pay more for covered services. If you’re looking into Medicare Advantage, it’s important to know which providers are in the network — especially if keeping your favorite doctor is essential.

International coverage

Both Original Medicare and Medicare Advantage plans generally do not provide coverage outside of the United States. However, if you have Original Medicare and are an avid world traveler, you might consider switching from a Medicare Advantage plan to a Medigap plan that covers emergency medical care internationally. Another option is to purchase a standalone travel medical policy that can supplement your Medicare benefits when traveling outside the United States.

Different types of Medicare Advantage plans

There are a few different types of Medicare Advantage plans:

· Health Maintenance Organization (HMO) Plans

· Preferred Provider Organization (PPO) Plans

· Private Fee-for-Service (PFFS) Plans

· Special Needs Plans (SNPs)

HMO

An HMO plan is a type of plan that provides coverage within a particular network of doctors and providers, with a few exceptions. Most HMOs also require a referral from your primary care physician before seeing a specialist. It may be possible to receive an out-of-network benefit, but you may have to pay the total cost of the service if you receive healthcare outside of your network.

PPO

A PPO plan also utilizes a network of doctors, specialists and hospitals. However, you can receive care at providers outside of your network, as long as the service is covered. Keep in mind that you may have to pay a higher price for the service. You will likely save money by using “preferred” providers.

PFFS

A PFFS plan offers you coverage at any Medicare-approved doctor, healthcare provider or hospital. It’s always a good idea to ensure that your doctor accepts this specific type of plan’s payment terms. If you need emergency care, the coverage stands whether the provider accepts the payment terms or not.

SNPs

An SNP plan provides coverage and benefits to individuals with specific diseases, healthcare needs or limited income. The list of benefits, providers and accepted doctors within the network is formulated with the plan’s recipients in mind. Chronic illnesses such as heart failure, neurological disorders or autoimmune disorders are just a few of the qualifying conditions. You generally have to receive care from an in-network doctor or provider, but there are exceptions.

How do I sign up?

If you think a Medicare Advantage plan may be right for you, reach out to us for help. Our PlanEnroll licensed insurance agents can help guide you through the coverage options available in your area, or you can shop for Medicare plans here! The consultation is free, with no obligation. It’s a smart and simple way to find a plan that fits your needs.

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We do not offer every plan available in your area. Currently we represent 0-78 carriers which offer 0-2,613 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program to get information on all of your options. This is a solicitation for insurance.