How Medicare Advantage works
When you enroll in a Medicare Advantage plan, you’re still on Medicare — you’re just receiving your Part A and Part B benefits through a private insurance company instead of directly from the government. Most plans also fold in Part D drug coverage and extra benefits Original Medicare doesn’t include.
Common plan types
- HMO (Health Maintenance Organization): Typically requires using in-network providers and getting referrals to see specialists, often at a lower cost.
- PPO (Preferred Provider Organization): More flexibility to see out-of-network providers, usually at a higher cost.
- SNP (Special Needs Plan): Designed for people with specific chronic conditions, those in institutional care, or those dually eligible for Medicare and Medicaid.
- PFFS (Private Fee-for-Service): Determines how much it pays providers and how much you owe, with fewer network restrictions in some cases.
Extra benefits many plans include
Beyond hospital and medical coverage, many Medicare Advantage plans offer dental, vision, and hearing coverage, fitness program memberships, transportation to medical appointments, and an annual out-of-pocket maximum that Original Medicare alone doesn’t have.
Frequently asked questions
When can I enroll in or switch a Medicare Advantage plan?
During your Initial Enrollment Period, the Annual Enrollment Period (October 15 – December 7 each year), or the Medicare Advantage Open Enrollment Period (January 1 – March 31), which allows one plan switch. Certain life events also trigger Special Enrollment Periods.
Will I still have Original Medicare if I choose an Advantage plan?
Yes. You keep Medicare Part A and Part B — the Advantage plan simply becomes how those benefits are administered and often expanded upon.
Are my doctors covered under a Medicare Advantage plan?
It depends on the plan's network. We check your current doctors and pharmacies against each plan's network before you enroll, so there are no surprises.
Do Medicare Advantage plans have a maximum out-of-pocket limit?
Yes — unlike Original Medicare alone, Advantage plans are required to cap your annual out-of-pocket costs for covered services. The exact limit varies by plan.
Can I switch from Medicare Advantage back to Original Medicare?
Yes, typically during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period. You may also want to consider a Medicare Supplement plan at that time, though acceptance may be subject to medical underwriting outside your initial enrollment windows.
