Medicare Advantage (Part C): A Plain-Language Overview

Medicare Advantage, also called Part C, is one of two main ways to get your Medicare coverage. Here’s a general, plain-language look at how it works so you can understand the basics before comparing options.

What Medicare Advantage is

Medicare Advantage is an alternative way to get your Part A (hospital) and Part B (medical) coverage. Instead of receiving those benefits directly through Original Medicare, you get them through a private plan that is approved by Medicare. You still have Medicare, and you generally continue to pay your Part B premium.

How these plans generally work

• Networks: many plans use provider networks, such as HMOs or PPOs. You may need to use doctors and hospitals in the plan’s network, and some plans require referrals.
• Drug coverage: many plans include Part D prescription drug coverage; some do not.
• Costs: plans set their own copays, coinsurance, and yearly out-of-pocket limits, and these can change from year to year.
• Service areas: plans are offered in specific areas, so availability depends on where you live.

Questions worth asking

• Are my current doctors and hospitals in the plan’s network?
• Are my prescriptions covered, and how?
• How does coverage work if I travel or spend part of the year in another state?
• What could my costs look like if I need a lot of care in a year?

You can’t use both together

Medicare Advantage and Medicare Supplement (Medigap) are two different paths. A Medigap policy only works with Original Medicare, so it can’t be used to pay costs in a Medicare Advantage plan. If you join a Medicare Advantage plan, you generally can’t use a Medigap policy at the same time.

Enrollment periods to know

• Annual Enrollment Period (October 15 to December 7): you can join, switch, or drop a Medicare Advantage or Part D plan, or return to Original Medicare. Changes generally take effect January 1.
• Medicare Advantage Open Enrollment Period (January 1 to March 31): if you’re already in a Medicare Advantage plan, you can make one change to a different Medicare Advantage plan or return to Original Medicare.
• Other enrollment periods may apply when you first become eligible or in certain special situations.

For more on how switching works between the two paths, see Medicare Supplement vs. Medicare Advantage: The Switching Rules and Medicare Supplement (Medigap): A Plain-Language Overview.

Talk it through, with no obligation

If you’d like to talk through how this fits your situation, you’re welcome to schedule a no-obligation conversation This is a solicitation for insurance. or call me at 346-258-7080. Before we discuss any specific Medicare plans, we’ll complete a Scope of Appointment, which records the types of plans you’d like to talk about. You can also get information on all of your options from Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP).

Chris Gavrel, independent licensed insurance agent

This page is for general educational purposes only. Medicare rules and enrollment periods can change. Confirm current details with Medicare.gov or 1-800-MEDICARE.

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