The short answer
How does Medicare Advantage work?
Medicare Advantage is another way to receive Medicare Part A and Part B benefits through a private plan approved by Medicare. Plans can use local provider networks, set cost sharing and coverage rules, and often include Part D drug coverage. Availability, benefits, networks, and costs vary by county and year.
Use this guide to understand the basics, then verify current coverage rules and costs before you enroll.
How these plans work
You remain enrolled in Medicare, continue paying any required Part B premium, and receive covered Part A and Part B services through the plan. The plan sets its network, service area, cost sharing, and coverage rules within Medicare requirements.
Questions worth asking
- Are your doctors, hospitals, and pharmacies in network?
- Are your prescriptions on the formulary and at what tier?
- What are the premium, deductible, copays, and yearly out-of-pocket limit?
- Do referrals or prior authorization apply?
- How does the plan handle care while traveling?
- Which dental, vision, hearing, or other extras are included, and what limits apply?
Availability is local
Plans and benefits vary by county and can change from year to year. Confirm the plan's current evidence of coverage, provider directory, formulary, and enrollment rules before enrolling.
Illustrative example
Comparing access and cost rules
One person may prefer a Medicare Advantage plan with a local network and bundled drug coverage. Another may value broader access through Original Medicare and separately consider Part D and Medigap. This example does not identify a better option; the useful choice depends on providers, prescriptions, travel, budget, and eligibility.
Ready for your next step?
Put what you learned into practice.
Start with your ZIP code to review plans available in your area, or ask for help from a licensed insurance agent.
Related questions
Frequently asked questions
Does Medicare Advantage replace Medicare?
No. You remain enrolled in Medicare, but the private Medicare Advantage plan administers your covered Part A and Part B services under the plan's rules.
Can I keep my doctor with Medicare Advantage?
That depends on the specific plan's current provider network and the doctor's participation. Check the plan directory, contact the provider and plan, and verify participation before enrollment.
Do Medicare Advantage plans cover prescriptions?
Many Medicare Advantage plans include Part D prescription coverage, but not all do. Check the plan formulary, pharmacy network, tiers, and coverage restrictions for every medication.
Is a zero-dollar premium Medicare Advantage plan free?
No. A zero-dollar plan premium does not eliminate the Part B premium or the deductibles, copays, coinsurance, and other costs that may apply when you receive care.
Can Medicare Advantage benefits change?
Yes. Premiums, benefits, formularies, provider networks, and cost sharing can change for a new plan year. Review the plan's annual notices and current documents.
Primary sources
- Your Medicare coverage choices — Medicare.gov
- What Medicare costs — Medicare.gov