What Is Medicare Advantage and How Does It Work?
If you’re new to Medicare or reviewing your options, you’ve probably heard the term Medicare Advantage—also known as Medicare Part C.
But what does it actually mean?
And how is it different from Original Medicare?
This guide explains what Medicare Advantage is, how it works, what it covers, and who it may be right for, in clear, simple language.
What Is Medicare Advantage?
Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits.
Instead of getting your coverage directly through Original Medicare (Part A and Part B), you receive your benefits through a private insurance company approved by Medicare.
These plans are required to provide everything Original Medicare covers—and many include additional benefits.
What Does Medicare Advantage Typically Cover?
Medicare Advantage plans must cover:
Hospital care (Part A)
Doctor visits and outpatient care (Part B)
Most plans also include:
Prescription drug coverage (Part D)
Dental benefits
Vision coverage
Hearing benefits
Over-the-counter (OTC) allowance cards
Fitness or wellness programs
Transportation assistance (plan-dependent)
👉 Benefits vary by plan and ZIP code, which is why reviewing options matters.
📞 Need help understanding which Medicare Advantage plans are available to you?
Call Medicare Plan Assistance at (561) 808-9410 to review your options and benefits.
How Does Medicare Advantage Work?
When you enroll in a Medicare Advantage plan:
The plan becomes your primary coverage
You use the plan’s network of doctors and hospitals
You pay copays or coinsurance for services
The plan sets an annual out-of-pocket maximum
Once you reach that maximum, the plan pays 100% of covered services for the rest of the year.
This built-in spending cap is something Original Medicare does not offer.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans, including:
HMO (Health Maintenance Organization)
Requires in-network care
Primary care doctor coordination
Referrals often required
PPO (Preferred Provider Organization)
Allows out-of-network care at higher cost
More flexibility with providers
Referrals usually not required
Special Needs Plans (SNPs)
Designed for people with specific conditions or financial situations
Often include enhanced benefits
Each type works differently depending on your healthcare needs.
📞 Unsure which type of Medicare Advantage plan fits your situation?
Call (561) 808-9410 to speak with Medicare Plan Assistance and get clarity before enrolling.
How Much Does Medicare Advantage Cost?
Costs vary by plan, but may include:
$0 monthly premium (many plans offer this)
You still pay your Part B premium
Copays for doctor visits and specialists
Prescription copays
Annual out-of-pocket maximum
Some plans are very affordable—but only if your doctors and medications are covered.
Medicare Advantage vs Original Medicare: Here’s a simple comparison:
Neither option is “better” for everyone—it depends on your priorities.
Who Is Medicare Advantage Best For?
Medicare Advantage may be a good fit if you:
Want lower monthly premiums
Like having extra benefits included
Are comfortable using a provider network
Want an annual cap on out-of-pocket costs
It may not be ideal if you:
Travel frequently
Want unrestricted access to providers
Have doctors who don’t accept Advantage plans
📞 Thinking about switching or enrolling for the first time?
Call Medicare Plan Assistance at (561) 808-9410 to review whether Medicare Advantage makes sense for you.
When Can You Enroll in Medicare Advantage?
You can enroll or change Medicare Advantage plans during:
Your Initial Enrollment Period
The Annual Enrollment Period (Oct 15 – Dec 7)
Certain Special Enrollment Periods
Missing the right window can limit your options.
Why Getting Help With Medicare Advantage Matters
Medicare Advantage plans:
Change every year
Vary by county
Have different networks and drug lists
Choosing the wrong plan can lead to:
Losing your doctor
Higher medication costs
Unexpected out-of-pocket expenses
That’s why personalized guidance matters.
Get Help Understanding Medicare Advantage Today
If you’re considering Medicare Advantage—or already enrolled and unsure if it’s still the right fit—Medicare Plan Assistance can help you:
Compare plans available in your area
Check doctors and prescriptions
Understand costs and benefits
Enroll correctly and on time
📞 Call (561) 808-9410 today to speak with Medicare Plan Assistance and get answers tailored to your situation.