Medicare
Medicare Advantage: Pros, Cons, and Choosing the Best Plan
Medicare Advantage (MA), known as Medicare Part C, is a type of private insurance plan. You can get your Medicare benefits through MA instead of directly from the government.
Some MA plans offer extra benefits not available through original Medicare. These include dental and vision coverage and transportation to healthcare appointments.
When choosing an MA plan, it’s important to consider out-of-pocket costs, medication coverage, healthcare network, and referral requirements.
Choosing between original Medicare and a Medicare Advantage (MA) plan can be confusing. With MA, a private insurance company provides your Medicare benefits. These insurers offer all the services covered by original Medicare and sometimes more.
But with all the MA options available, how do you choose a plan? Finding the right MA plan takes some homework, but it’s worth it.
Medicare Advantage, also called Medicare Part C, is a health plan offered by private insurers that work with Medicare. It offers Medicare Part A (hospital) and Part B (medical) benefits in one plan.
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When you’re eligible for Medicare, you can choose between original Medicare or an MA plan. Here’s what you need to know about how these plans work:
Enrollment: To join an MA plan, you must first enroll in Medicare Part A and Part B. You’ll still pay your Part B premium. The private insurer may charge an extra premium.
Primary insurer: If you choose an MA plan, the private insurance company becomes your primary insurer. They handle claims and payments for Medicare-covered services, like hospital stays and medical visits.
Coverage: MA plans often include benefits that aren’t typically covered by original Medicare. But each plan has different rules, costs, and coverage limitations.
Private insurance companies consistently push MA plans, especially around open enrollment. This is because Medicare pays money to private insurers when people enroll in their MA plans.
The average Medicare Advantage plan premium is expected to be around $17 per month in 2025. This is in addition to your Medicare Part B premium, which is $185 monthly in 2025.
In some cases, you may not have to pay an MA premium. In 2025, two-thirds of MA plans with prescription medication coverage won’t charge an extra premium beyond the Part B premium in 2025. Some MA plans even cover part or all of your Part B premium.
Your actual MA plan cost depends on which plan you choose and any out-of-pocket expenses, such as:
Deductibles
Copays
Coinsurance
If you have a chronic condition and are eligible for Medicare, a Medicare Advantage special needs plan might be right for you. Here’s what makes these plans different and how to enroll.
Switching from Medicare Advantage to original Medicare? Ask yourself these questions before changing plans.
No, you can’t combine Medigap with a Medicare Advantage plan. Here are some key differences between Medigap and Medicare Advantage and how to choose the right plan.
Medicare Advantage plans offer benefits and drawbacks compared with original Medicare. Here are a few pros and cons of MA plans to consider.
MA plans may provide benefits that original Medicare does not, such as coverage for:
Vision care, including eye exams and glasses
Dental services, like cleanings and fillings
Hearing care, such as hearing aids
These extra benefits vary between MA plans. It’s important to compare the details of the plans you are considering.
MA plans set a limit on your yearly out-of-pocket costs. In 2025, this limit is $9,350 for in-network care. After you hit this cap, you pay nothing for covered in-network services for the rest of the plan year. With original Medicare, there is no cap on what you pay out of pocket for copays, deductibles, and coinsurance. But starting in 2025, all Medicare plans will have a $2,000 cap on prescription medication costs.
Copays for healthcare visits, prescription medications, and other services are often lower with an MA plan compared with original Medicare (without Medigap coverage). For example, you may pay a $10 copay to see a healthcare professional under an MA plan. But you’d pay 20% of the Medicare-approved amount under original Medicare, which could be a higher cost.
MA usually combines medical and prescription medication coverage in one plan. This means you get your Part A, Part B, and usually Part D benefits bundled together. MA prescription medication coverage can help you avoid high medication costs.
With original Medicare, you need to buy a separate Part D prescription medication plan.
MA plans generally have restricted healthcare networks, and these networks can change yearly. With an MA plan, you need to receive care from in-network healthcare professionals and hospitals to keep your costs down. Out-of-network care may cost you more or may not be covered at all.
Some MA plans require a referral or prior authorization from your primary care provider before seeing certain specialists. This may limit your access to specialists. With original Medicare, you can usually go to any specialist without a referral.
MA plans may be restrictive if you travel often or live in multiple places.
Let’s say you live in New Jersey for half of the year and Florida for the other half. An MA plan in New Jersey might not cover you while you’re in Florida. Or you may have to pay higher out-of-network costs for the care you receive in Florida.
With original Medicare, you have the option to buy a Medigap policy, which is Medicare supplement insurance. But you cannot buy a Medigap policy with an MA plan.
You might have to pay an extra premium on top of your Part B premium with some MA plans.
There are many types of Medicare Advantage plans. Here’s how each plan works and who they might be right for:
Type of plan | How it works | Who it’s for |
Health maintenance organization (HMO) | HMO plans usually include prescription medication coverage. You must use in-network healthcare professionals and facilities.You typically need referrals for specialists. | People who want lower premiums and are comfortable with network restrictions |
Preferred provider organization (PPO) | PPO plans include prescription medication coverage. You can generally visit out-of-network healthcare professionals. Referrals are not needed for specialists. | People who want flexibility in choosing healthcare professionals and facilities and are willing to pay more for out-of-network access |
Private fee-for-service (PFFS) | PFFS plans may not cover prescription medications. This plan gives you the freedom to get care where you want, with no referrals. | People looking for flexibility in where they obtain their care and who are willing to pay an extra premium |
Special needs plan (SNP) | SNPs must include Part D medication coverage. Healthcare networks and referral rules for specialists vary by plan. | People seeking specialized care options who have specific healthcare needs |
Medicare medical savings account (MSA) | MSA plans don’t charge an extra premium. They don’t offer prescription medication coverage either. But they generally don’t have networks, and referrals aren’t needed for specialists. | People who want to control their healthcare spending, don’t mind having a high-deductible health plan, and are willing to manage a savings account |
To qualify for a Medicare Advantage plan, you must:
Have Medicare Part A and Part B
Live in the plan’s service area
Be a U.S. citizen or living legally in the U.S.
You can join an MA plan even if you have a preexisting condition or end-stage renal disease.
You can enroll in only one MA plan at a time. If you have employer or union coverage, check with your benefits administrator first. Joining an MA plan might affect your coverage.
Here’s when you can sign up for an MA plan:
During the annual enrollment period from October 15 to December 7. Your coverage will start on January 1 of the following year in this case.
If you are new to Medicare, you have a 7-month window to enroll. This consists of the 3 months before your 65th birthday, the month of your birthday, and 3 months after.
If you have a qualifying life event, you may be eligible to sign up during a special enrollment period. Examples include other health coverage and getting married.
Between January 1 and March 31, you can switch MA plans (or return to original Medicare).
You can enroll in an MA plan by:
Using the Medicare plan finder tool to compare plans and enroll online
Calling the 1-800-MEDICARE (1-800-633-4227) helpline
Contacting the private insurer offering the plan
Getting help from an insurance agent or broker
Reaching out to your State Health Insurance Assistance Program
Make sure your preferred hospitals, healthcare professionals, and medications will be covered before choosing an MA plan. Also, learn about the plan’s network and referral rules, copays, and other details before enrolling.
Medicare Advantage plans are all-in-one alternatives that have low or no monthly premiums. They include hospital care, medical services, and usually prescription medication benefits. Medigap plans, on the other hand, are supplemental plans you can add only to original Medicare. Medigap plans often have higher premiums but give you more flexibility in where you get care. With Medigap, you’ll still need to buy separate Part D (prescription medication) coverage. But you’ll get help paying for original Medicare’s deductibles and coinsurance.
Yes, you can switch from Medicare Advantage to original Medicare during Medicare annual enrollment (October 15 to December 7) or MA open enrollment (January 1 to March 31). If you switch from MA to original Medicare, you will need to sign up for a Medicare Part D plan for prescription medication coverage. You may want to consider getting a Medigap policy to help with costs.
No, you don’t lose Medicare when you have an MA plan. You’re still in the Medicare program. MA provides your benefits through a private insurer instead of the government.
Yes, you can switch from Medicare Advantage to original Medicare during Medicare annual enrollment (October 15 to December 7) or MA open enrollment (January 1 to March 31). If you switch from MA to original Medicare, you will need to sign up for a Medicare Part D plan for prescription medication coverage. You may want to consider getting a Medigap policy to help with costs.
No, you don’t lose Medicare when you have an MA plan. You’re still in the Medicare program. MA provides your benefits through a private insurer instead of the government.
Medicare Advantage (MA) plans offer all-in-one coverage through private insurance companies as an alternative to original Medicare. These plans often include extra benefits and lower up-front costs. But they may restrict you to a healthcare network and may require referrals for specialists. When considering MA plans, think about your budget, your health needs, and where you prefer to get care. It takes some research to find the right MA plan, but it’s worth the effort.
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