What Medicare Advantage is, in plain words
Medicare Advantage is also called Part C. A private insurance company runs the plan, and Medicare pays that company each month to do it. The plan must cover everything Original Medicare covers, except hospice, which Original Medicare still handles.
Most plans add extras. Many include prescription drug coverage, and some add dental, vision, hearing or fitness benefits. Extras vary a lot from plan to plan, so ask what is actually in the one you are looking at.
How you pay
You keep paying your Part B premium to Medicare. Some plans also charge their own monthly premium, and some charge none. Beyond that, you usually pay copays when you see a doctor or enter a hospital.
Part A costs depend on work history, the type of care and the applicable benefit period. Check current Medicare amounts and the coverage conditions before estimating your share.
Many plans set lower limits. The limit does not include your premium, and drug costs follow separate rules.
The main plan types
Plans differ in how much freedom you have to pick doctors.
| Type | How it works | What to ask |
|---|---|---|
| HMO | You pick from the plan's network, usually with a primary care doctor | Are my doctors and my hospital in the network? |
| PPO | You may see doctors outside the network, usually at a higher cost | How much more do I pay out of network? |
| PFFS | The plan sets what it pays, and providers must agree to accept it | Do my doctors accept this plan's terms? |
| SNP | A plan built for people with certain conditions or with Medicaid | Am I in a group this plan was built for? |
Dual eligible plans are one kind of SNP. Read about dual eligible special needs plans if you have both Medicare and Medicaid.
Questions to ask before you join
A plan can look good on paper and still disappoint you. Ask these questions first.
- Are my doctors, specialists and hospital in the network ?
- Are my medicines on the drug list, and at what cost?
- Does the plan need referrals or approval before certain care? This is called prior authorization.
- What happens if I need care while traveling or staying out of state?
- What is the total yearly limit, and does it fit my budget in a bad year?
You can look up providers on the plan's own website or on Medicare Plan Finder. Calling the doctor's office to confirm is even better.
Medicare Advantage in Brick, NJ: what to know about doctors
Brick residents often see doctors in more than one town. A plan may cover a hospital in Brick but leave out a specialist in Toms River or Lakewood. Ask about each provider by name.
If you spend winters away, ask how the plan treats care outside its service area. Some plans offer limited travel coverage, and others do not.
When you can join or change
You can join when you first get Medicare, or during open enrollment from October 15 to December 7. A change you make then starts on January 1 of the following year. If you are already in a plan, you have one more chance from January 1 to March 31 to switch.
If you join Medicare Advantage for the first time, you may also have a trial period to return to Original Medicare. Medicare.gov explains these rights on its coverage options page.
Medicare Advantage or Medigap?
You cannot use Medigap with a Medicare Advantage plan. Pick one road or the other. Our Medigap guide and plan cost comparison lay out how each one works.
If you leave Medicare Advantage later and want Medigap, the insurer may be able to ask health questions. Plan for that before you switch.
Keep reading
This page is part of the Coverage & Costs library, inside our Medicare insurance guide for Brick, NJ. Related pages:
Unfamiliar word? Check the Medicare glossary.
Compare Medicare Advantage plans with an insurance professional
Bring your doctors and your medicine list. An insurance professional can compare plans available where you live, and you decide whether to enroll.
Frequently Asked Questions
Is Medicare Advantage the same as Original Medicare?
No. Original Medicare is Parts A and B, run by the federal government. Medicare Advantage is a private plan that replaces them, and it must cover what they cover.
Do I still pay the Part B premium with Medicare Advantage?
Yes. You keep paying the Part B premium to Medicare. Some plans also charge a separate monthly premium.
Can I keep my doctor on a Medicare Advantage plan?
Only if your doctor is in the plan's network, or the plan allows out-of-network care. Confirm with your doctor's office before you join.
Can I switch Medicare Advantage plans during the year?
Usually only during open enrollment or the January to March window for those already in a plan. Certain life events can also open a Special Enrollment Period.
Do all Medicare Advantage plans include drug coverage?
No. Many do, but some do not. If your plan has no drug coverage, you generally cannot add a stand-alone Part D plan to it.