Medicare Advantage Explained
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What Medicare Advantage Covers
Every Medicare Advantage plan must provide at least the same coverage as Original Medicare, but most go further with extra perks.
Depending on the plan, you may receive:
- Doctor and hospital coverage (Parts A & B)
- Prescription drug coverage (Part D)
- Routine dental, vision, and hearing care
- Wellness and fitness memberships (like SilverSneakers®)
- Transportation to medical appointments
- Allowances for over-the-counter (OTC) items
- 24/7 telehealth access
Each plan sets its own network, rules, and benefits, so comparing options is key.
Types of Medicare Advantage Plans
Not all Advantage plans are the same. Here are the most common types:
HMO (Health Maintenance Organization)
You choose doctors and hospitals within a local network. Referrals are often required for specialists.
Typically lowest premiums and copays.
PPO (Preferred Provider Organization)
More flexibility to see out-of-network providers (usually at higher cost).
Ideal if you want provider choice.
PFFS (Private Fee-for-Service)
You can see any doctor who agrees to the plan’s terms.
Less common, but flexible.
SNP (Special Needs Plans)
Tailored for people with specific conditions, dual eligibility (Medicare + Medicaid), or who live in institutions.
How is Medigap Different From Medicare Advantage?
Choosing between Medigap and Medicare Advantage (Part C) often comes down to lifestyle and cost preferences.
Medigap vs. Medicare Advantage
| Feature | Medigap | Medicare Advantage |
|---|---|---|
| Provider Choice | Any doctor or hospital that accepts Medicare | Must use plan’s provider network |
| Drug Coverage | Separate Part D plan required | Usually included |
| Out-of-Pocket Maximum | None (but Medigap limits your costs) | Has a yearly max ($9,350 in 2025) |
| Upfront Premiums | Higher | Lower (sometimes $0) |
| Out-of-Pocket Costs per Visit | Minimal or none | Copays and coinsurance vary |
| Extras (dental, vision, gym) | Usually not included | Often included |