Medicare Advantage isn't extra coverage on top of Medicare. It's a different way of getting your Medicare: instead of Part A and Part B coming straight from the federal program, a private plan approved by Medicare provides them.
What a Medicare Advantage plan must cover
Every Medicare Advantage plan has to cover everything Original Medicare covers, with one exception: hospice care stays with Original Medicare even if you're in a plan. Beyond that:
- Most plans include Part D drug coverage in the same plan.
- Many add extra benefits Original Medicare doesn't cover, such as some dental, vision or hearing care. What's included varies by plan and can change each year.
- Every plan has a yearly out-of-pocket limit on covered Part A and Part B services. Once you reach it, the plan pays in full for the rest of the year.
How networks change things
Most Medicare Advantage plans work with a network of doctors and hospitals. The plan type tells you how strict that network is:
| Plan type | How it usually works |
|---|---|
| HMO | You generally use in-network providers, except in emergencies, and often need a referral to see a specialist |
| PPO | You can go out of network, usually at a higher cost |
| Special Needs Plan (SNP) | Limited to people with specific conditions or circumstances, such as having both Medicare and Medicaid |
Plans can also require prior authorization — the plan's approval before certain services are covered.
What you still pay
You generally keep paying your Part B premium, plus whatever the plan charges: possibly its own premium, deductibles, and copays or coinsurance. Those amounts are set plan by plan, each year.
Three things to check in any plan: that your doctors are in its network, that your prescriptions are on its drug list at a tier you can live with, and what its yearly out-of-pocket limit is.
Who can join
You need to have both Part A and Part B and live in the plan's service area. You can join, switch or leave during the fall Open Enrollment Period, and people already in a plan get a second window from January 1 to March 31. Our guide to fall Open Enrollment has the details.
The Medicare cheat sheet
Parts A, B, C and D on a single page, plus the dates that matter this fall. The email version is coming soon.