Medicare Advantage

What is Medicare Advantage?

Medicare Advantage, also referred to as Medicare Part C, presents an alternative approach to receiving Medicare benefits. Approved by Medicare, private insurance companies offer these plans, which encompass the coverage provided by Original Medicare (Part A and Part B). In addition, Medicare Advantage plans frequently offer supplementary benefits such as prescription drug coverage, dental, vision, and hearing services. To fully benefit from these plans, participants may need to utilize designated networks of doctors and hospitals.


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Types of Medicare Advantage plans

There are different types of Medicare Advantage plans to choose from, including:

Health Maintenance Organization (HMO)

HMO plans rely on in-network doctors and mandate referrals for specialists.

Preferred Provider Organization (PPO)

PPO plans apply varying rates depending on whether services are received from in-network

Private Fee-for-Service (PFFS)

PFFS plans, are unique payment arrangements that provide greater flexibility in choosing healthcare providers.

Medical Savings Account (MSA)

MSA plans combine high deductible health plans with medical savings accounts, creating a comprehensive healthcare solution.

Special Needs Plans (SNPs)

SNPs (Special Needs Plans) assist in managing long-term healthcare expenses associated with chronic conditions.


Numerous Medicare Advantage plans provide the following array of benefits:


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Benefits of Medicare Advantage

Compared to original Medicare, there may be advantages if you choose a Medicare Advantage plan.

Convenient coverage options

Unlike Original Medicare, which provides only hospital insurance and medical insurance, Medicare Advantage plans offer a comprehensive solution by combining multiple types of coverage into a single, convenient plan. With Medicare Advantage, you can access additional benefits such as prescription drug coverage and supplemental coverage, eliminating the need to purchase separate Medicare Part D and Medigap plans. This simplifies your healthcare coverage and streamlines the process.

Personalized plan structures

Medicare Advantage provides various plan types tailored to your specific needs. For instance, if you have a chronic health condition, an SNP (Special Needs Plan) Advantage plan can assist with managing your medical costs effectively.

If you prioritize the freedom to choose your healthcare providers, a PPO (Preferred Provider Organization) or PFFS (Private Fee-for-Service) plan might better align with your preferences. Additionally, many Medicare Advantage plans offer additional services such as dental, vision, and hearing coverage, providing you with comprehensive healthcare options.

Cost-saving opportunities

Medicare Advantage plans present several advantages, including the absence of premiums and low or no deductibles. Moreover, these plans often impose limits on the maximum out-of-pocket expenses you'll bear within a plan year, providing financial protection.

Furthermore, studies have indicated that transitioning to a Medicare Advantage plan can result in cost savings for laboratory services and medical equipment. Opting for a Medicare HMO plan may yield even greater savings on healthcare services obtained from your HMO network.

Coordinated medical care

Numerous Medicare Advantage plans incorporate coordinated medical care, where healthcare providers engage in active communication to ensure seamless coordination between various healthcare services and specialties. This collaborative approach establishes a dedicated healthcare team, minimizing unnecessary expenses and addressing concerns such as medication interactions.

A study conducted by researchers revealed that coordinated care was linked to higher patient ratings and positive experiences reported by medical staff, further highlighting the benefits of this approach.


Here are tips to find the best Medicare Advantage plan for your needs


Understanding your previous healthcare expenses can assist in determining your budget, including what you can afford to allocate towards premiums and out-of-pocket costs. While certain plans may have $0 premiums and deductibles, others might require payments ranging from a few hundred dollars and upwards.

If you rely on medication, it's essential to find a Medicare Advantage plan that includes prescription drug coverage or consider purchasing a separate Part D plan. Make sure to carefully review the formulary (list of covered drugs) of any plans you are considering to ensure that your specific medications are covered.

Numerous Advantage plans offer additional coverage options like dental, vision, and hearing services. Contacting different carriers will help you explore the specific benefits and offerings of their plans.

Given that over 40 percent of Americans have chronic health conditions, it is crucial to consider which plan will best meet your long-term healthcare needs.

If maintaining your current healthcare provider is a priority, it is essential to determine which Medicare plans they accept or participate in.

CMS (Centers for Medicare & Medicaid Services) utilizes a Five-Star Rating System to assess the quality of care offered by Medicare Advantage and Part D plans. This rating system evaluates various aspects such as chronic condition management, care accessibility, member experience, customer service, drug pricing, and more. CMS releases updated star ratings annually to provide valuable insights into the performance of these plans.