Medicare

Medicare Advantage (Part C) —All-in-One Medicare Coverage

Medicare Advantage plans bundle Medicare Part A, Part B, and usually Part D prescription drug coverage into a single private plan. Many plans include extra benefits like dental, vision, and hearing. We compare options across multiple carriers to help you find the right fit.

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Overview

What Is Medicare Advantage?

Medicare Advantage (also called Part C) is an alternative to Original Medicare offered by private insurance companies approved by Medicare. Instead of getting your benefits directly from the federal government, you receive them through the private plan — which must cover at least everything Original Medicare covers.

Part A and Part B combined. Medicare Advantage plans include all the hospital coverage of Part A and all the medical coverage of Part B in one plan. You still pay your Part B premium, but all your Medicare benefits flow through the private plan.

Often includes Part D. Most Medicare Advantage plans (called MAPD plans) include prescription drug coverage, eliminating the need for a separate Part D plan. Drug formularies and cost-sharing vary by plan.

Network considerations. Medicare Advantage plans use provider networks. Your current doctors and hospitals may or may not be in-network for a given plan. This is one of the most important factors to verify before enrolling — and in King County, the major Puget Sound systems are not in every network.

Medicare Advantage vs. Original Medicare

MA: often $0 or low monthly premium beyond Part B
MA: network restrictions on providers
MA: out-of-pocket maximum caps annual exposure
Original Medicare: use any provider that accepts Medicare
Original Medicare: no out-of-pocket maximum without supplement
Original Medicare: typically paired with Medigap and Part D

Plan Types

Types of Medicare Advantage Plans

HMO Plans

Health Maintenance Organization plans require you to use a network of providers. Referrals are typically needed to see specialists. Generally offer the lowest premiums within Medicare Advantage.

PPO Plans

Preferred Provider Organization plans allow you to see any provider, in-network or out, without referrals. More flexibility than HMOs but typically higher premiums and out-of-pocket costs for out-of-network care.

HMO-POS Plans

A hybrid plan that functions like an HMO for most services but allows some out-of-network care at a higher cost for designated services. Offers slightly more flexibility than a standard HMO.

Special Needs Plans (SNPs)

Plans designed for specific populations: people with certain chronic conditions (C-SNP), people eligible for both Medicare and Medicaid (D-SNP), or people living in institutions (I-SNP).

MAPD Plans

Medicare Advantage plans that include Part D prescription drug coverage. The most common type. Combines medical and drug coverage in one plan with one premium.

Extra Benefits

Many plans offer benefits Original Medicare does not cover — routine dental, vision, hearing aids, fitness memberships, over-the-counter allowances, and transportation. Benefits vary significantly by plan and geography.

What to Evaluate

Key factors when comparing plans.

Provider network. Verify that your current primary care physician, specialists, and preferred hospitals are in-network. Network adequacy varies significantly by plan and geography and is often the most critical factor in plan selection.

Total cost of care. Compare the full cost picture: monthly premium, deductibles, copays for doctor and specialist visits, hospital cost-sharing, and the annual out-of-pocket maximum. Low premiums can mask high cost-sharing.

Drug formulary. If the plan includes Part D coverage, verify that your current medications are covered and at what tier. Drug formularies change annually and can significantly affect your total out-of-pocket costs.

Star ratings. CMS assigns Medicare Advantage plans a star rating of 1 to 5 based on quality and performance measures. Higher-rated plans generally provide better member experience and care coordination.

Prior authorization. Many plans require prior authorization for certain services, procedures, and medications. Understanding these requirements is important for people with complex health needs.

Bring to your appointment:

Your Medicare card
A list of your doctors and clinics
A current medication list with dosages
Your current plan, if you have one
Any letters from Medicare or your plan

Frequently Asked Questions

Is Medicare Advantage better than Original Medicare?

Neither is universally better. Medicare Advantage often offers lower premiums and extra benefits, but comes with network restrictions and prior authorization requirements. Original Medicare offers broader provider access and pairs well with Medigap for comprehensive coverage. The right choice depends on your health needs, financial situation, preferred doctors, and how much you value flexibility vs. cost.

Can I switch Medicare Advantage plans?

Yes. During the Annual Enrollment Period (October 15 to December 7), you can switch Medicare Advantage plans, switch from Medicare Advantage to Original Medicare, or make other Medicare coverage changes for coverage starting January 1. There is also a Medicare Advantage Open Enrollment Period from January 1 to March 31.

Do I still pay for Part B if I have Medicare Advantage?

Yes. You continue to pay your Medicare Part B premium even with Medicare Advantage. Your Medicare Advantage plan then provides your Part A and Part B benefits instead of Original Medicare paying them directly.

What happens if I need care out of network?

For HMO plans, out-of-network care is generally not covered except in emergencies. For PPO plans, out-of-network care is covered but at higher cost-sharing. If you travel frequently or value provider flexibility, a PPO plan or Original Medicare with Medigap may be better suited to your needs.

Does a Medicare Advantage advisor cost me anything?

No. Licensed Medicare advisors are paid by the insurance carriers, not by you. The premium and plan benefits are identical whether you enroll through an agent or directly with the carrier or through Medicare.gov. Independent advisors like Sav-On compare options across multiple carriers to find the best fit.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.

Compare Medicare Advantage plans across multiple carriers.

We help you evaluate networks, extra benefits, drug formularies, and total cost — independent guidance at no cost to you.

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