Medicare Coverage
Medicare Advantage (Part C), explained
Medicare Advantage is another way to get your Medicare. A private plan approved by Medicare covers your hospital and medical benefits. Most plans also include drug coverage. You still have Medicare.
This is a summary, not a complete list of rules. Plans and costs change by county and year. We are an independent agency, not the federal Medicare program. For official information, use Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY: 711.
What Medicare Advantage is
You must have Part A and Part B to join. You must live in the plan’s service area — usually your county. You keep paying your Part B premium.
- One plan, most of your coverage. Part A, Part B, and usually Part D are bundled. You typically show the plan’s member card at the doctor.
- You cannot use Medigap with it. A Supplement policy will not pay Advantage copays. If you want Medigap, you stay with Original Medicare.
- Emergency care is covered. Go to the nearest ER if you need it, even when you are away from home. Routine visits out of the area are a different story — ask the plan first.
HMO
You generally use doctors in the plan’s network, except in an emergency. You often need a primary care doctor and a referral to see a specialist.
PPO
There is still a network, but you can usually go outside it for a higher cost. Many PPO plans do not require a referral.
Your doctors
Before you enroll, check that your doctors and hospital take the plan. Call the office. Online directories can be out of date. If a doctor leaves the network later, you generally pick another in-network doctor for regular care.
Some tests, procedures, and brand-name drugs need the plan’s approval first. That is called prior authorization. If you skip it, the plan may not pay.
What you pay
A $0 plan premium does not mean care is free. You still pay Part B. You can also owe copays when you use the plan.
- Part B premium
- You keep paying this. In 2026 the standard amount is $202.90 a month. Higher-income people pay more.
- Plan premium
- Some Advantage plans charge extra each month. Some do not. Compare more than the monthly price.
- Copays when you use care
- Doctor visits, hospital stays, and drugs often have a set dollar amount or a percentage. These amounts are in the plan’s papers.
- Yearly out-of-pocket limit
- Advantage plans cap what you pay in a year for covered Part A and Part B services. After you hit that limit, the plan pays 100% of those services for the rest of the year. Drug costs may not count toward that cap.
- Extra benefits
- Dental, vision, hearing, gym, or an over-the-counter card may be included. They are not guaranteed, and they change by plan and year. Read that year’s chart.
When you can join or switch
1. When you first get Medicare
You can join an Advantage plan during your Initial Enrollment Period if you already have Part A and Part B.
2. Each fall: October 15–December 7
Open Enrollment. You can join, switch, or drop an Advantage plan. Changes usually start January 1.
3. January 1–March 31, if you already have Advantage
You can make one change: switch to another Advantage plan, or go back to Original Medicare and join a drug plan. This window is not for people on Original Medicare who want to join Advantage for the first time.
4. If something in your life changes
Moving out of the plan’s area, losing other coverage, or qualifying for Extra Help or Medicaid can open a Special Enrollment Period.
Good to know
- Keep your red, white, and blue Medicare card. For everyday visits, show the plan card.
- Each fall, read the Annual Notice of Change. Copays, doctors, and extras can change on January 1 even if the plan name stays the same.
- You have the right to appeal if the plan denies a service or a claim. Do not ignore the letter.
- We do not offer every plan in your area. A licensed agent can check your doctors and drugs against plans sold where you live.
Related: Medicare Supplement · Part D drug plans · Medicare basics
Ready to review Medicare options?
Request a plan review from a licensed agent, or call us. Submitting a form does not enroll you. We do not offer every plan in your area.