Medicare Advantage Plans

What a Medicare Advantage plan is

A Medicare Advantage plan, also called Part C, is offered by a private insurance company approved by Medicare. It replaces the way you receive your Part A and Part B benefits. You stay enrolled in Medicare and continue to pay your Part B premium, but the plan becomes the one place your coverage comes from.

Most of these plans bundle hospital, medical, and prescription drug coverage into a single plan, and many include extras that Original Medicare does not cover.

What these plans typically include

• Hospital and medical coverage. Everything Part A and Part B cover, provided through the plan.
• Prescription drug coverage. Built into most plans, so a separate Part D plan is usually not needed.
• An annual out-of-pocket maximum. A yearly cap on what you pay for covered medical services, which Original Medicare alone does not have.
• Additional benefits in many plans, which can include dental, vision, hearing, fitness programs, and transportation.

Not all plans offer all of these benefits. What is included, and what it costs, varies by plan, by carrier, and by the county you live in.

How the plan types differ

HMO

You choose providers within the plan's network and usually select a primary care doctor. Referrals are often needed to see a specialist. Out-of-network care is generally covered only in an emergency.

PPO

You can see providers outside the network, though you pay more when you do. Referrals are usually not required.

SNP (Special Needs Plan)

Built for people in a specific situation, such as those with both Medicare and Medicaid, those living in an institution, or those with certain chronic conditions. Eligibility rules apply.

What to weigh before you choose

A Medicare Advantage plan is a good fit for some people and not for others. These are the questions worth answering first:

If network freedom matters most to you, a Medigap plan paired with Original Medicare may suit your situation better. We can compare both side by side.

What you pay

You continue paying your Part B premium. Beyond that, a Medicare Advantage plan may have its own monthly premium, and you pay copays or coinsurance when you use services. Some plans in some areas carry no additional monthly premium, though a lower premium does not always mean lower total cost, since what you pay also depends on how often you use care and which medications you take.

The useful comparison is the whole picture: premium, copays, drug costs, and the out-of-pocket maximum together. That is the comparison I walk you through.

When you can enroll or change plans

Initial Enrollment Period

The seven-month window around your 65th birthday, starting three months before the month you turn 65.

Annual Enrollment Period

October 15 to December 7 each year. You can join, switch, or drop a Medicare Advantage or drug plan, with changes effective January 1.

Medicare Advantage Open Enrollment

January 1 to March 31. If you are already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare.

Special Enrollment Periods

Certain life changes, such as moving out of your plan's service area or losing other coverage, open a window outside the usual dates.

How I help

I start with your situation: the doctors you want to keep, the medications you take, the pharmacy you use, and what you want your coverage to do. Then I check which plans in your county actually work with those, and I lay out the differences in plain language, including the trade-offs. You make the decision. I handle the enrollment and stay available afterward for questions and your annual review.

My help costs you nothing. Agents are paid by the insurance companies, and your premium is the same with or without me.