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What are Medicare Advantage Plans?

A Medicare Advantage plan is a private health insurance plan that is Medicare-approved.  Medicare Advantage plans are either PFFS plans, PPO plans, HMO plans, or Special needs plans.  Sometimes referred to as an “all-in-one” alternative to standard Medicare, this plan may cover your Part A (hospital insurance), B (medical insurance), and D (drug coverage) benefits. Many plans may also offer additional benefits, such as vision, dental, hearing, and even gym memberships. 

When choosing a Medicare Advantage plan, you may also opt to receive coverage for more services, such as over-the-counter drugs or transportation to doctor visits. Plans can be customized for condition-specific treatments with benefits pertaining to chronically ill recipients. 

Rules for Medicare Advantage Plans

Medicare Advantage plans work by directing your Medicare to pay a set monthly amount for your care. As a result, you will receive coverage for all of your Part A and Part B services, as well as additional benefits if offered in your plan. 

Rules may apply to how you can receive services, such as:

  • Possibility of a referral to a specialist (HMO)
  • The need to receive medical care that is considered non-urgent 


In order to get a medicare advantage plan, you must also, 

  • Continue to pay for your Medicare Part B premium
  • 100% be enrolled in both Medicare Part A and Medicare part B 
  • Live in the plan’s service area


Services from providers that are outside of the plan’s network or service area may not be covered by your Medicare advantage plan, so to ensure the lowest costs, make sure to use doctors and providers in your plan’s service area. 

Pros to Medicare Advantage Plans

There is a major possibility that the Medicare Advantage Plans may cost you less.  Your insurer determines the premium of your Medicare Advantage plan, and while you must still continue to pay your Part B premium, some Advantage plans may have premiums as low as $0.  In addition, your cost-sharing may be less with a Medicare Advantage plan. An Advantage plan also limits your out-of-pocket expenses, as once the maximum is reached, you won’t have to pay for medical services covered by your plan for the rest of the year.