Medicare Advantage: Another Way to Receive Your Medicare Coverage
Medicare Advantage plans are offered by private insurance companies approved by Medicare and provide Medicare Part A and Part B coverage through the plan. Many plans also include additional benefits and prescription drug coverage, depending on the plan.
What Is Medicare Advantage?
A clear, simple explanation of how Medicare Advantage works.
Medicare Advantage is also known as Medicare Part C. These plans are offered by private insurance companies approved by Medicare and provide Medicare Part A and Part B coverage through the plan.
Many Medicare Advantage plans include prescription drug coverage, and plans may also include additional benefits not provided by Original Medicare. However, benefits, costs, networks, and rules vary by plan.
Medicare Advantage plans provide Medicare Part A and Part B coverage through a private plan. They do not replace your Medicare entitlement.
How Is Medicare Advantage Different from Original Medicare?
Neither approach is better than the other — it depends on your situation.
Original Medicare
Original Medicare
- Part A and Part B are provided through Original Medicare.
- People may obtain standalone Part D prescription drug coverage.
- Medicare Supplement coverage may be available to help with certain Original Medicare out-of-pocket costs.
- Original Medicare generally provides broad access to providers who accept Medicare.
Learn more about Medicare basics and Medicare Supplement coverage.
Medicare Advantage
Medicare Advantage
- Part A and Part B coverage is provided through a private Medicare-approved plan.
- Plans commonly use provider networks.
- Prescription drug coverage is often included.
- Plans may offer additional benefits.
- Costs and plan rules vary.
What Can Medicare Advantage Plans Include?
Coverage and benefits vary by plan. Here are common categories to understand.
Medical Coverage
Medicare Part A and Part B services are covered through the plan. This includes hospital care, physician services, outpatient care, and other Medicare-covered medical services.
Prescription Drug Coverage
Many Medicare Advantage plans include Part D prescription drug coverage. However, plan formularies and drug costs can differ, so the same medication may be covered differently from one plan to another.
Additional Benefits
Depending on the plan, additional benefits may include services such as routine dental, routine vision, hearing, fitness, transportation, over-the-counter allowances, and other supplemental benefits.
Cost Structure
Plans may differ in premiums, copayments, coinsurance, deductibles, and maximum out-of-pocket limits. Costs can vary significantly from one plan to another.
Benefits and costs vary by plan. Not every plan includes the same benefits, and availability of specific benefits depends on the plan selected.
Your Doctors and Providers Matter
Provider participation can make a real difference in your coverage experience.
Medicare Advantage plans may use provider networks, and network participation can vary by plan, carrier, medical group, IPA, and service area.
People who want to keep particular doctors should verify those relationships before selecting a plan. We do that for you.
Hospital and specialist access may also matter, not just the primary-care physician. A provider may accept Medicare generally but not participate in a specific plan's network, so it is important to verify network participation for the specific plan being considered.
Your Medications Matter, Too
Drug coverage can differ from one plan to another.
Drug coverage can differ by plan based on factors such as formulary inclusion, drug tier, pharmacy, preferred pharmacy status, quantity limits, prior authorization, step therapy, and plan cost-sharing.
The same prescription can cost differently under different plans. Understanding how your medications are covered is an important part of reviewing Medicare Advantage options.
What Should You Consider?
These are considerations, not automatic ranking rules. What matters most depends on your situation.
Understanding Plan Network Types
Common Medicare Advantage structures, explained in simple terms.
HMO
HMO plans typically use a defined provider network and may require members to receive most non-emergency care within that network.
PPO
PPO plans may provide more flexibility to receive care outside the preferred network, usually with different costs and plan rules.
Plan structures and rules can vary. Not all HMOs or PPOs operate identically.
Look Beyond the Extra Benefits
Extra benefits can be valuable, but they are one part of a larger picture.
Benefits such as dental, vision, hearing, fitness, transportation, allowances, or similar extras can be valuable. However, the decision should also consider provider access, prescriptions, medical costs, maximum out-of-pocket exposure, plan rules, and overall fit with your healthcare needs and preferences.
Thoughtful comparison means looking at the whole plan — not just the additional benefits that may be highlighted in marketing materials.
How Fair & Kind Helps
A simple, personal process — no pressure, just clear guidance.
Understand Your Needs
Fair & Kind begins by gathering relevant information about your healthcare needs, providers, medications, preferences, and priorities.
Review Available Options
Applicable Medicare Advantage options can be reviewed based on your circumstances and preferences.
Compare the Differences
Fair & Kind helps you understand meaningful differences in provider access, prescription coverage, costs, benefits, plan rules, carrier preferences, and other relevant factors.
Help You Move Forward
Fair & Kind can assist with appropriate next steps once you understand the available choices.
Considering Original Medicare Instead?
Some people choose Original Medicare along with separate prescription drug coverage and, where appropriate, Medicare Supplement coverage. Neither approach is better than the other — it depends on your situation.
Learn more about Medicare 101.
Frequently Asked Questions
Common questions about Medicare Advantage, answered in plain English.
Let's Find Coverage That Fits Your Situation
Contact Fair & Kind for help understanding Medicare Advantage choices and how they might fit with your coverage needs.
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