What Is Medicare Advantage?

If you’ve had health insurance through an employer or through the Marketplace, Medicare Advantage may feel familiar.  A Medicare Advantage plan is a type of Medicare coverage offered by private insurance companies approved by Medicare. Instead of using Original Medicare by itself, you receive your benefits through one plan with one ID card.  For many people, it can be a more affordable way to receive Medicare coverage because many plans have low or even $0 monthly premiums, beyond your Medicare Part B premium.

Most Medicare Advantage plans include:

• Hospital coverage (Part A) & Medical coverage (Part B)

• Prescription drug coverage (Part D)

• Extra Benefits

With Original Medicare, you may need:

• Medicare Part A & Medicare Part B

• A separate Stand-alone Part D prescription drug plan

• A Medicare Supplement plan

Medicare Advantage simplifies that by putting your coverage into one major medical plan with one ID card—much like the coverage many people had while working.

That’s one reason Medicare Advantage has become so popular.

Understanding Networks: HMO vs. PPO

Like employer plans, Medicare Advantage plans typically use a network of doctors and hospitals. There are two main types:

HMO (Health Maintenance Organization)

An HMO generally requires you to use doctors, hospitals, and specialists within the plan’s network. Some HMOs also require referrals to see a specialist. 

PPO (Preferred Provider Organization)

A PPO has in-network and out-of-network benefits. You can use doctors and hospitals outside the network, although you’ll usually pay more when you do.  PPO plans do not require referrals to see specialists.  For people who travel or spend time in another state, a PPO can be a better option.

Extra Benefits Original Medicare Does Not Cover

One of the biggest reasons people choose Medicare Advantage is because of the extra benefits.  Many plans include:

• Dental coverage

• Vision coverage

• Hearing benefits

• Gym memberships such as SilverSneakers® or Renew Active®

• Over-the-counter allowances in a few plans depending on where you live

• Transportation or meal benefits in some plans

Original Medicare does not cover most routine dental, vision, hearing, or gym memberships.  So for some people, Medicare Advantage offers more value for their monthly dollar.

What About Prior Authorizations?

Some Medicare Advantage plans require prior authorization before certain tests, procedures, or services are covered.  That means the plan wants to review and approve the service before it is done.  This has been one of the biggest concerns people have about Medicare Advantage.  However, beginning in 2026, Original Medicare is also starting to require prior authorization for certain services in some situations, so this is no longer something unique to Medicare Advantage.

You’re Not Locked In

A common misconception is that choosing Medicare Advantage means you’re stuck with it forever. Fortunately, that isn’t true in New York.  New York is one of the few states that allows people to move back to Original Medicare and buy a Medicare Supplement plan without medical underwriting or worrying about pre-existing conditions. That means you do not have to answer health questions or be concerned about being turned down because of your medical history.

When Can You Switch?

AEP - Each year during Medicare’s Annual Election Period, from October 15 through December 7, you can:

• Switch from one Medicare Advantage plan to another

• Leave Medicare Advantage and return to Original Medicare

• Add or change a stand-alone Part D prescription drug plan

Any changes you make during that period take effect January 1 of the following year.

OEP - If you already have a Medicare Advantage plan on January 1 and decide after the holidays that you’d like something different, there is also a separate Medicare Advantage Open Enrollment Period from January 1 through March 31. During that time, you can make one additional change:

• Switch to a different Medicare Advantage plan, or

• Return to Original Medicare and add a Part D drug plan

That change becomes effective the first day of the following month after the plan receives your request.

Is Medicare Advantage Right for You?

Medicare Advantage can be a good fit if you:

• Prefer lower monthly premiums

• Like having one plan and one ID card

• Want prescription coverage included

• Would use benefits like dental, vision, hearing, or a gym membership

• Are comfortable using a network of doctors and hospitals

For others, Original Medicare with a Supplement may be a better fit.

There isn’t one “best” option—only the one that works best for your doctors, prescriptions, budget, and comfort level.  Medicare Plan Brokers work hard to find the right plan considering your doctors, your medications, your specific needs and your budget.  If you’d like help comparing your options, please call 631-337-3625.  There is no cost to you for our services.

Medicare Advantage Benefits