Medicare Advantage
One plan, bundled benefits, a network to check
Medicare Advantage — Part C — is private coverage that delivers your Part A and Part B benefits in a single plan, usually with drugs and extras included.
How it works
You keep paying your Part B premium. The Advantage plan then becomes how you actually receive care, and many plans carry little or no additional premium on top.
In exchange, care runs through the plan’s network, and some services need prior authorization. Instead of a predictable monthly cost, you pay copays as you go — with a cap on what you can spend in a year, which Original Medicare alone does not have.
Plans are priced and built county by county, so what’s available in Hillsborough County may differ from Merrimack. They also change every year, which is why an annual review matters even if nothing in your life has changed.
What to check before enrolling
- Are your doctors in the network, by name
- Is your hospital in the network
- Are your prescriptions on the formulary
- What is the maximum out-of-pocket for the year
- Which extras are included, and what are the real allowances
- Whether referrals or prior authorization are required
Common plan types
HMO
Care stays in network and usually runs through a primary care doctor who coordinates referrals. Typically the lowest cost, with the least flexibility.
PPO
You can go outside the network at a higher cost, and referrals generally aren’t required. More freedom, usually a higher premium.
Special Needs Plans
Built for people with specific conditions, those in institutional care, or those eligible for both Medicare and Medicaid. Eligibility rules apply.
Where Advantage tends to work well — and where it doesn't
It tends to suit people who are comfortable within a network, who like the idea of dental and vision bundled in, and who would rather keep monthly costs low and pay as they use care.
It tends to suit people less if they travel extensively, spend part of the year in another state, see specialists at multiple health systems, or would find an unpredictable year financially difficult.
That last point is worth sitting with. A healthy year on an Advantage plan usually costs less than a Supplement. A serious year can cost considerably more, up to the plan’s annual maximum.
We check your doctors and drugs by name
Not a general comparison — your actual providers and your actual prescriptions, against each plan available in your county.