Frequently Asked Questions About Medicare Advantage

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare (Parts A and B) offered by private insurance companies approved by and under contract with Medicare. These plans must cover all the services that Original Medicare covers, but may also include additional benefits such as prescription drug coverage (Part D), vision, dental, and hearing. Plans, premiums, and benefits vary by plan and location.

HMO (Health Maintenance Organization) plans typically require you to get care from doctors and hospitals within a specific network and usually require a referral from your primary care doctor to see a specialist. They generally have lower premiums and out-of-pocket costs. PPO (Preferred Provider Organization) plans give you more flexibility to see out-of-network providers, though at higher cost sharing. Neither type requires a referral to see a specialist. Your licensed specialist can help you determine which structure fits your healthcare habits and budget.

Medicare Advantage plans may offer benefits not covered by Original Medicare, which can vary widely by plan and location. Possible additional benefits include: prescription drug coverage (Part D), vision benefits (eye exams, glasses, contact lenses), dental coverage (cleanings, x-rays, fillings), hearing benefits (exams, hearing aids), fitness program memberships, transportation assistance to medical appointments, over-the-counter health product allowances, and care management programs. Not all plans include all benefits. A licensed specialist can confirm what is available in your ZIP code.

Many Medicare Advantage plans include prescription drug coverage (Part D) as part of the plan. These are called MA-PDs (Medicare Advantage Prescription Drug plans). However, not all Medicare Advantage plans include drug coverage, so it is important to confirm this when comparing plans. A licensed specialist can identify plans in your area that include the specific medications you take on their formulary (covered drug list).

Yes. In most cases, you must be enrolled in both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) to enroll in a Medicare Advantage plan. You must also continue to pay your Part B premium while enrolled in a Medicare Advantage plan. If you are approaching 65 or are already 65 and not yet on Medicare, a licensed specialist can explain your enrollment pathway.

The Annual Enrollment Period (AEP) runs from October 15 through December 7 each year. During this period, any Medicare beneficiary can join, switch, or drop a Medicare Advantage plan or Medicare Prescription Drug Plan (Part D). Changes made during AEP take effect on January 1 of the following year. This is the primary window for reviewing and changing your coverage annually.

A Special Enrollment Period (SEP) is a window outside of the regular Annual Enrollment Period during which you may be eligible to join, switch, or drop a Medicare Advantage plan. SEPs are triggered by qualifying life events such as: moving to a new address outside your plan's service area, losing other coverage (such as employer insurance), qualifying for Medicaid, or moving into or out of a nursing facility. A licensed specialist can confirm whether you qualify for a SEP.

Yes. You can return to Original Medicare during the Annual Enrollment Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31) if you are already enrolled in a Medicare Advantage plan. If you switch back to Original Medicare, you may also be able to add a standalone Part D prescription drug plan and a Medicare Supplement (Medigap) policy, subject to medical underwriting in most states.

It depends on the specific plan and your doctors. Medicare Advantage plans use networks of doctors and hospitals. HMO plans typically require you to use in-network providers (except in emergencies), while PPO plans allow you to see out-of-network providers at a higher cost. A licensed specialist can check whether your current doctors — including specialists and hospitals — are in-network for the specific plans available in your ZIP code before you make any changes.

Yes. By law, all Medicare Advantage plans must include an annual out-of-pocket maximum, which caps how much you pay for covered services in a calendar year. Once you reach the limit, the plan pays 100% of covered services for the rest of the year. Original Medicare (Parts A and B) alone does not have an out-of-pocket maximum — this is one of the key protections Medicare Advantage plans provide. Out-of-pocket maximums vary by plan and are set each year.

No. The plan comparison service offered through Plans Medicare is provided at no cost to you. Licensed Medicare agents are compensated by the insurance carriers when you enroll in a plan — not by you. There is no charge for the consultation, regardless of whether you enroll in any plan.

No. Plans Medicare, operated by Ebbiflow LLC, is a lead generation and referral service. We connect you with licensed insurance agents who are authorized to sell Medicare Advantage plans in your state. We are not an insurance carrier, and we are not affiliated with Medicare or any government agency. Licensed agents you speak with are independent professionals who hold active state insurance licenses.

Plans Medicare currently serves Medicare beneficiaries in Florida, Texas, and Georgia. We connect consumers with licensed agents in cities including Orlando, Tampa, Miami, Jacksonville, St. Petersburg, Fort Lauderdale, Houston, San Antonio, Dallas, Austin, Atlanta, and Savannah. If you are outside these areas, contact Medicare.gov or call 1-800-MEDICARE for assistance.