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Deciding which healthcare plans are ideal for your wellness and life circumstances can be confusing, especially when you have various options.

Medicare Advantage Plans - How Do They Work?
How Do Medicare Advantage Plans Work

Medicare Advantage plans are an insurance option available to qualifying individuals to cover various needs. Here's a look at how these plans work.

Original Medicare vs. Medicare Advantage Plans

Original Medicare is a government health plan that operates via fee-for-service and has two parts:

  • Part A covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care, and more.
  • Part B covers doctors' and other healthcare providers' services and outpatient care, as well as durable medical equipment, home health care, and some preventive services.

After beneficiaries pay their deductible, Medicare pays its portion of the approved amount. Original Medicare, on its own, doesn't provide prescription drug coverage. However, Medicare Advantage plans encompass Parts A and B while also offering Part D, which is prescription drug coverage.

Medicare Advantage plans are known as Part C. It's a bundled plan that offers Parts A, B, and D, and it can be purchased through private insurance companies.[1]

How Medicare Advantage Works?

Medicare advantage plans offered by private companies for Medicare beneficiaries.[2]

In general, Medicare is available to individuals age 65 or older. Medicare can also cover individuals under 65 years old who receive Social Security benefits. There are also special exceptions for individuals who have end-stage renal disease (ESRD).

How to Obtain Medicare Advantage Coverage?

One of the easiest ways to obtain coverage for a medicare advantage plan is to contact a private insurer and work with them on the paperwork and process.[3] They can help guide you and ensure you get the best coverage for your needs.

What Medicare Advantage Plans Cover?

Along with covering hospital insurance, medical insurance, and prescription drugs, Medicare Advantage plans also cover the following:

When enrolling in a medicare advantage plans, you can choose which services are covered in your plan.[5]

What to Consider with Medicare Advantage Coverage?

When discussing options with your insurance provider, here are some things to remember.


How much are the premiums and deductibles?

What about other costs?

What will you be paying for services like doctor visits or hospital stays?

With Medicare Advantage plans, beneficiaries have annual limitations on out-of-pocket costs. In other words, once you reach a certain limit outlined by your plan, you won't be required to pay for covered services for the remainder of the year.


Does your selected plan offer the prescription drug coverage you need? If you’re in good health, you likely won't need to visit specialists. However, if you have a poor health history, consider options for future coverage.

Choice of Provider

Medicare Advantage plans only cover doctors and hospitals in-network. When deciding on your choice of provider, ask yourself the following questions:

  • Does your current doctor accept the coverage?
  • Is your preferred in-network doctor accepting new patients?
  • Do you need to get referrals?
  • Will you have to choose your hospital from a network?

Some plans do offer out-of-network coverage. Your insurance provider will help you determine what coverage is available to you within your selected plan.

Open Enrollment in Medicare

During open enrollment, which takes place every year, you can enroll in a new Medicare plan or make changes and adjustments to your current plan.

Open enrollment allows you to add the coverage you think you may need while eliminating coverage that's no longer useful.

Getting Started with Medicare

Open enrollment season is right around the corner — and the time to act is now. After identifying which services you'll need in the coming year, it’s time to enroll in Medicare.

Carefully weigh the information provided regarding Medicare Advantage plans and make the right choice for you and your loved ones.

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We review published medical research in respected scientific journals to arrive at our conclusions about a product or health topic. This ensures the highest standard of scientific accuracy.

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Eileen Lamb

Eileen was born and raised in France and has been living in Texas for 6 years with her husband and two little boys, Charlie (5) and Jud