What is Medicare Advantage?

How Medicare Advantage works

Instead of getting your benefits directly from the federal government, you get them through a private insurer that contracts with Medicare. These "bundled" plans cover everything Original Medicare covers (Parts A and B) and usually include prescription drug coverage (Part D) too — all under one insurance card.

• A private insurer administers your benefits while you remain in the Medicare program.
• Most plans use HMO or PPO networks — meaning specific doctors and hospitals.
• Going out-of-network typically costs more, or may not be covered at all.
• Some services may require prior authorization before they're covered.

What Advantage plans often include

• Routine dental, vision, and hearing care.
• Fitness memberships (like SilverSneakers) and wellness programs.
• Telehealth visits and 24/7 nurse lines.
• Over-the-counter benefits, transportation, and meal delivery (varies by plan).
• A yearly out-of-pocket maximum that caps what you'll spend on covered services.

Advantages

• Often lower (or $0) monthly premiums on top of your Part B premium.
• Extra benefits Original Medicare doesn't offer.
• Just one card and one set of paperwork.
• Coordinated care with your primary care provider.

Considerations

• Provider networks — your preferred doctors and hospitals must participate.
• Some plans require referrals before seeing a specialist.
• Prior authorization may apply to certain services.
• Plan availability and benefits vary by county.

Common plan types

• HMO (Health Maintenance Organization): Usually requires staying in-network and getting referrals to see specialists.
• PPO (Preferred Provider Organization): Offers more flexibility to see out-of-network providers, though staying in-network is cheaper.
• SNP (Special Needs Plan): Tailored to people with specific chronic conditions or those who have both Medicare and Medicaid.