Most people approaching 65 hear about Medicare Advantage and aren't quite sure what it is, how it's different from Original Medicare, or whether it makes sense for their situation. We're going to walk you through it the way a friend who happens to be a licensed agent would.
Medicare Advantage is sometimes called Part C. It's an alternative way to get your Medicare coverage. Instead of getting your Part A and Part B coverage directly from the federal Medicare program, you choose to get it through a private insurance company that has been approved by Medicare to offer plans in your area.
You don't leave the Medicare program when you do this. You stay enrolled in Medicare Part A and Part B. You also keep paying your Part B premium each month, just like everyone else on Medicare. What changes is who's actually administering your day-to-day coverage. Medicare pays the private plan a set amount each month to take care of you, and you use the plan's ID card at doctor visits and pharmacies instead of your red, white, and blue Medicare card.
That's the whole concept. It's the same Medicare you were going to be on either way — just delivered through a private company instead of directly from the federal government.
Still with us? You're already further along than most people who walk into a Medicare appointment. If a 15-minute call with a licensed agent sounds easier than reading another article, we're here.
Talk to an agentThe other path most people take is Original Medicare paired with a Medicare Supplement plan (also called Medigap), and usually a stand-alone prescription drug plan (Part D).
With that setup, you stay on Original Medicare for your hospital and medical coverage, the supplement helps pay the share Original Medicare leaves to you, and the drug plan handles your prescriptions. Three pieces, working together.
Medicare Advantage bundles those pieces differently. Most Medicare Advantage plans include prescription drug coverage built right in, so it's one plan instead of three. You hand a single ID card to your doctor and pharmacist.
Neither path is automatically the right one. They're built differently and they work for different people. The honest answer to "which is better" is: it depends on your doctors, your prescriptions, where you live, how much you travel, and how you want your costs to feel month to month. That's exactly the conversation a licensed agent has with you.
Medicare Advantage plans come in a few flavors. The two most common are HMO and PPO. They work differently when you actually go to the doctor.
HMO stands for Health Maintenance Organization. With an HMO, you pick a primary care doctor from the plan's network, and that doctor coordinates your care. If you need a specialist, your primary care doctor usually gives you a referral. Care is generally only covered when you stay inside the plan's network — except in emergencies.
HMOs are more structured. The trade-off for that structure tends to be lower premiums and a more coordinated care experience.
PPO stands for Preferred Provider Organization. PPOs are more flexible. You can usually see specialists without a referral, and you can use providers outside the plan's network — though out-of-network care typically costs you more.
PPOs trade some of the structure of an HMO for more freedom in how you choose your care.
There are a few other types — Special Needs Plans (SNPs) for people with specific health conditions or financial situations, and Private Fee-For-Service plans (PFFS), which work a bit differently again. Most people end up choosing between an HMO or PPO. We'll walk you through which one fits your situation when we talk.
HMO or PPO? Most people get this question answered in about ten minutes on the phone. Want us to walk you through it?
Get a free comparisonMost of the questions people ask us about Medicare Advantage come down to a handful of things. These are the ones we'd ask you about on a call.
The single biggest question. Medicare Advantage plans use networks. If your doctor isn't in the plan's network, you may need to switch doctors or pay more to keep them. Before recommending any plan, we check whether your doctors are in-network.
Each plan has a formulary — the list of medications it covers and how they're priced under the plan. Two people on the same medications can have very different experiences on two different plans. We compare formularies against your actual prescription list.
Medicare Advantage plans are local. The plans available in one ZIP code aren't necessarily available in another. If you're in the middle of a move, that changes the conversation.
If you split time between states, or travel a lot to see family, how a plan handles out-of-area care matters. Some plans handle it well. Others don't.
If you have ongoing health conditions, the way a plan handles specialists, hospitals, and care coordination matters more than it does for someone who only sees a doctor for an annual physical.
Some people want low predictable costs and don't mind a network. Others want maximum flexibility and are willing to pay for it. The right plan structure depends on which of those is more like you.
This part trips a lot of people up, so we'll keep it simple. You can't enroll in or change a Medicare Advantage plan whenever you feel like it. Federal rules set specific windows during the year.
The 7-month window around your 65th birthday — three months before, the month of, and three months after. This is when most people first enroll in Medicare and choose between Original Medicare and Medicare Advantage. Missing this window can mean penalties that follow you for life. If you're approaching 65, this is the one to watch.
October 15 through December 7 every year. During this window, anyone with Medicare can switch between Medicare Advantage plans, switch from Original Medicare to Medicare Advantage, or drop Medicare Advantage and go back to Original Medicare. Whatever you change takes effect January 1.
January 1 through March 31. If you're already on a Medicare Advantage plan and decide it's not working out, this window lets you switch to a different Medicare Advantage plan or go back to Original Medicare.
Triggered by life events — moving to a new area, losing other coverage, qualifying for assistance programs, and a few others. SEPs let you make changes outside the standard windows.
Not sure which window applies to you? That's one of the first things a licensed agent can clear up. It's a quick conversation.
Talk to an agentNo hard sell. No 47-page brochures mailed to your house. Three steps and a real conversation.
Your ZIP, the doctors you want to keep, the prescriptions you take, what you want your coverage to do for you. That's most of what we need.
A licensed independent agent reviews the Medicare Advantage plans available in your area, checks them against your doctors and your prescriptions, and walks you through the strongest matches.
You pick what fits. We handle the paperwork, and we stay with you year after year for plan reviews — because plans change every year, and the plan that fits today may not be the right one in two years.
It costs you nothing. We're paid by the carrier you enroll with. Your premium is the same whether you enroll through us, through the carrier directly, or through anyone else.
Tell us a bit about your situation and a licensed agent will reach out within one business day. No pressure to enroll in anything.
Most people who call us start with "I just don't know where to begin." That's fine. That's our entire job. One call, no pressure, no obligation. We'll walk you through your options and you decide what to do next.
By calling the number above, you will be connected to a licensed insurance agent. Mon–Fri 8am–8pm CT.
