What is Medicare Advantage?
What Are Medicare Advantage Plans? A Simple Guide
When you first become eligible for Medicare, you’ll quickly learn that you have important choices to make about your health coverage. One option many people consider is a Medicare Advantage plan—also known as Medicare Part C. But what exactly is a Medicare Advantage plan, and how does it differ from Original Medicare?
Let’s break it down in a clear and easy-to-understand way.
What Is a Medicare Advantage Plan?
A Medicare Advantage plan is an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies that contract with Medicare to provide your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits.
In short: You’re still in the Medicare program—you just receive your benefits through a private plan instead of directly through the government.
How Medicare Advantage Plans Work
When you join a Medicare Advantage plan:
You still get all the same services covered by Original Medicare.
Many plans offer additional benefits that Original Medicare does not cover.
You typically receive care through a network of doctors and hospitals.
You continue paying your Part B premium, and some plans may have an additional premium (though many offer $0 premium options).
What Do Medicare Advantage Plans Cover?
Every Medicare Advantage plan must provide at least the same level of coverage as Original Medicare. But most plans include extra benefits designed to give you more complete healthcare coverage.
Typical benefits include:
Hospital care (Part A)
Medical services (Part B)
Prescription drug coverage (Part D) — included in most plans
Dental and vision care
Hearing services and hearing aids
Fitness memberships (like SilverSneakers)
Over-the-counter (OTC) allowances
Transportation to medical appointments
Telehealth services
These added benefits are a major reason why Medicare Advantage plans continue to grow in popularity.
Types of Medicare Advantage Plans
There are several kinds of Medicare Advantage plans, and the type available to you depends on your location:
1. HMO (Health Maintenance Organization)
Uses a provider network
Requires referrals for specialists in most cases
Often has lower out-of-pocket costs
2. PPO (Preferred Provider Organization)
More flexibility to see providers inside or outside the network
No referrals needed for specialists
3. PFFS (Private Fee-for-Service)
Allows you to see any provider accepting the plan’s payment terms
Less common than HMOs and PPOs
4. SNPs (Special Needs Plans)
Designed for people with specific health conditions or financial needs
Includes Chronic Condition SNPs (C-SNP), Dual-Eligible SNPs (D-SNP), and Institutional SNPs (I-SNP)
Advantages of Medicare Advantage Plans
Medicare Advantage plans offer several benefits that many seniors find appealing:
All-in-one coverage (hospital, medical, and often drug coverage)
Low or $0 monthly premiums in many areas
Extra benefits not offered by Original Medicare
An annual out-of-pocket maximum — something Original Medicare does not include
This out-of-pocket maximum is a big deal because it places a cap on what you’ll pay for covered services each year.
Are Medicare Advantage Plans Right for You?
A Medicare Advantage plan may be a great fit if:
You want predictable, bundled coverage
You prefer extra benefits like dental, vision, and hearing
You’re comfortable using a provider network
You want potential savings through $0 premiums
However, if you want complete freedom to visit any doctor who accepts Medicare nationwide—or if you have frequent specialist visits—you may prefer Original Medicare with a Medigap policy.
Final Thoughts
Medicare Advantage plans can offer comprehensive coverage, valuable added benefits, and affordable costs for many people. Understanding how they work is the first step in deciding whether they’re right for your healthcare needs.
If you have questions about Medicare Advantage or want help comparing plans in your area, a licensed agent can guide you through the options available.