What Are People Asking?
● “What if I want Dental and Vision coverage?”
● “What if I want a low or $0 monthly premium?”
● “Will I still be able to see my doctors?”
● “Are there copays with Medicare Advantage?”
● “Is Medicare Advantage better than Original Medicare?”
● “Can I travel with a Medicare Advantage plan?”
● “What if I don’t like networks?”
● “Will my medications be covered?”
● “Is Medicare Advantage all-in-one coverage?”
What Is A Medicare Advantage Plan (Part C)?
A Medicare Advantage Plan, also known as Part C, is an alternative way to receive your Medicare benefits. Instead of using your red, white, and blue Medicare card alone, your coverage is provided through a private insurance company approved by Medicare.
These plans must cover everything that Original Medicare (Part A and Part B) covers, and many include additional benefits that Original Medicare does not offer.
What If I Want Dental and Vision Coverage?
This is one of the biggest reasons many people consider Medicare Advantage plans.
Most Medicare Advantage plans include:
● Dental coverage
● Vision coverage
● Hearing benefits
● Fitness programs (like gym memberships)
● Wellness extras
Original Medicare generally does not include routine dental, vision, or hearing coverage, so for individuals who value these additional benefits, a Medicare Advantage plan can feel more comprehensive.
However, it’s important to understand that coverage amounts and limits can vary by plan and by county.
What If I Want A Low Premium?
Another major reason people explore Medicare Advantage plans is the low monthly premium.
Many plans offer:
● $0 monthly premiums (you still pay your Part B premium)
● Predictable copays for services
● Built-in prescription drug coverage (Part D in many cases)
For individuals looking to manage monthly costs and avoid higher supplemental premiums, a Medicare Advantage plan may appear attractive at first glance. That said, lower premiums usually mean cost-sharing in the form of copays, coinsurance, and an annual out-of-pocket maximum.
Will I Still Be Able To See My Doctors?
This is a critical question — and one that should never be overlooked.
Most Medicare Advantage plans operate within:
● HMO networks (more common today)
● PPO networks (less common than before)
This means:
● You may need to use in-network doctors and hospitals
● Referrals may be required with some plans
● Out-of-network care may cost more (or may not be covered in certain plans)
If your doctors and hospitals are important to you, provider network verification is essential before enrolling. Your Medicare advisor will always check this for you.
Are There Copays With Medicare Advantage?
Yes. Unlike Medicare Supplement plans, Medicare Advantage plans typically include copays for services such as:
● Primary care visits
● Specialist visits
● Hospital stays
● Imaging and outpatient services
While many copays are reasonable, they can add up during years when you use more healthcare services. The trade-off is often lower monthly premiums in exchange for pay-as-you-go cost sharing.
Will My Medications Be Covered?
Many Medicare Advantage plans include prescription drug coverage, but formularies (drug lists) vary from plan to plan.
Things that matter:
● Medication tiers
● Preferred pharmacies
● Prior authorizations
● Step therapy requirements
This is especially important for higher-tier medications, where costs can differ significantly depending on the plan selected.
Is Medicare Advantage An All-In-One Plan?
For many people, yes. Medicare Advantage plans often
bundle:
● Hospital (Part A)
● Medical (Part B)
● Prescription Drugs (Part D)
● Extra Benefits (Dental, Vision, Hearing, Fitness)
This “all-in-one” structure is appealing to individuals who prefer simplicity and consolidated coverage under one plan.
When Might A Medicare Advantage Plan Be A Good Fit?
A Medicare Advantage plan may be a good fit if:
● You prefer lower monthly premiums
● You like having dental, vision, and hearing included
● You are comfortable using provider networks
● You want an annual out-of-pocket maximum for protection
● You are generally in good health and want predictable copays
Final Thoughts: Is It The Right Fit For You?
There is no one-size-fits-all answer when it comes to Medicare Advantage.
For some individuals, the extra benefits and low premiums make these plans a very practical and appealing choice.
However, if low copays, maximum flexibility, and no doctor or hospital networks are most important to you, a Medicare Supplement (Medigap) plan paired with Original Medicare may be a better fit.
The key is not what is advertised the most — but what is most appropriate for your personal healthcare needs, doctors, medications, and budget. Your Medicare Advisor will guide you to the most appropriate plan for your individual needs, helping you cut through the noise of commercials, mailers, and sales pitches and focus on what truly works best for you.
Frequently Asked Questions About Medicare Advantage Plans
Do I still have Medicare if I enroll in a Medicare Advantage plan?
Yes. You are still enrolled in Medicare. A Medicare Advantage plan simply administers your Part A and Part B benefits through a private insurance company approved by Medicare. You must continue paying your Part B premium even if your Medicare Advantage plan has a $0
monthly premium.
Can I switch out of a Medicare Advantage plan later?
In many cases, yes. During the Annual Enrollment Period (October 15 – December 7), you can review and change your plan for the following year. There is also a Medicare Advantage Open Enrollment Period (January 1 – March 31) that allows certain changes.
However, switching back to a Medicare Supplement plan in most states may require medical underwriting, so it’s important to choose carefully the first time.
Do Medicare Advantage plans have an out-of-pocket maximum?
Yes. One of the key features of Medicare Advantage plans is an annual maximum out-of-pocket limit. Once you reach that limit for covered medical services, the plan pays 100% of covered services for the rest of the year. This provides a level of financial protection that Original
Medicare alone does not include.
Are $0 premium Medicare Advantage plans really free?
Not exactly. While some plans have a $0 additional premium, you must still pay your Medicare Part B premium. In addition, you will typically have copays, coinsurance, and cost-sharing when you use medical services. The $0 premium refers only to the plan’s monthly cost, not your overall healthcare expenses.
