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Medicare Advantage: Finding the Right Plan for You

Is a Medicare Advantage Plan right for you? Good question. Before you can answer it, you need to understand what Medicare Advantage is and how it works. So let’s get started.

  1. What’s the difference between Original Medicare and Medicare Advantage (also known as Medicare Part C)?

Here’s the short answer:

– Original Medicare includes hospital insurance (Part A) and medical insurance (Part B), and is administered by the federal government.

– Medicare Advantage also includes Part A and Part B, but is administered by private insurance companies approved by Medicare.

  1. If both include Part A and Part B, what’s the “advantage” of a Medicare Advantage Plan?

There are several, in fact. While both Original Medicare and Medicare Advantage cover Part A and Part B, Medicare Advantage Plans typically have higher benefit amounts by having lower deductibles, copays, or coinsurance.

In addition, most plans include prescription drug coverage. Some also include benefits not covered by Original Medicare, such as vision, hearing, dental, and fitness services. Of course, you’ll likely pay extra for some of these services. Do your homework so you understand exactly what each plan covers and costs.

  1. How do Medicare Advantage Plans vary?

Medicare Advantage actually includes many different plan types. However, all Medicare Advantage plans are “managed care” plans, which means that the coverage you receive can vary if you go to a doctor, hospital or pharmacy that is not in the private insurance company’s network.

Here’s a quick overview of the two most common types of Medicare Advantage plans:

Health Maintenance Organization (HMO) Plans

– HMO plans require you stay within the plan’s network of doctors, other healthcare providers, and hospitals. Essentially this means you cannot see any doctor you want or go to the hospital of your choice if the hospital is not in the network.

– Exceptions are made for emergency care, out-of-area urgent care, and out-of-area dialysis.

Preferred Provider Organization (PPO) Plans

– PPO plans give you the option of seeking care in or outside of the plan’s network.

– You pay less when you visit doctors, other healthcare providers, and hospitals that belong to the plan’s network, and pay more when you seek care outside of the network.

  1. Who can choose a Medicare Advantage Plan?

According to, you can if you meet these three criteria:

– You currently reside in the plan’s service area. If you split time between two residences throughout the year, confirm the plan will cover you in both places.

– You have Medicare Part A and Part B.

– You do not have End-Stage Renal Disease (ESRD).

  1. When can you enroll in a Medicare Advantage Plan (or make changes to your current coverage)?

There are actually multiple answers to this question. We’ll walk through them one by one:

– The Initial Enrollment Period begins three months before the month you turn 65 and ends three months after the month you turn 65. So if you have a May birthday, your Initial Enrollment Period is February 1st to August 31st. During this time, you can enroll in a Medicare Advantage Plan.

– The Open Enrollment Period begins October 15th and ends December 7th. During this time each year, you can:

– Switch from Original Medicare to a Medicare Advantage Plan.

– Switch from a Medicare Advantage Plan to Original Medicare.

– Switch from one Medicare Advantage Plan to another

– The Medicare Advantage Disenrollment Period begins January 1st and ends February 14th. During this time, you can switch from a Medicare Advantage Plan to Original Medicare.

You can learn more about the Initial Enrollment Period, Open Enrollment Period, and Disenrollment Period for Medicare Advantage here.

In addition, you can make changes to your Medicare Advantage Plan when certain changes occur in your life. These are called Special Enrollment Periods (SEPs). The rules for each SEP can be found here.

Now that you know a little more about Medicare Advantage, you can find a plan that’s right for you. If you have additional questions about your options, visit, the official U.S. government site for Medicare.