Medicare Advantage (Part C)
An all-in-one alternative to Original Medicare.
What is Medicare Advantage?
Medicare Advantage (also known as Medicare Part C) is an alternative way to get your Medicare coverage. These plans are offered by private insurance companies approved by Medicare and provide all the coverage of Original Medicare (Part A and Part B), and often include additional benefits.
Key Features:
- Combines hospital (Part A), medical (Part B), and usually prescription drug (Part D) coverage in one plan
- May include extra benefits like dental, vision, hearing, and fitness programs
- Often has lower out-of-pocket costs than Original Medicare
- Yearly out-of-pocket maximum for added financial protection
Types of Medicare Advantage Plans
HMO (Health Maintenance Organization)
- •Must use doctors in the plan's network
- •Usually requires a primary care doctor
- •Need referrals to see specialists
- •Lower premiums and out-of-pocket costs
PPO (Preferred Provider Organization)
- •Can see out-of-network doctors (at higher cost)
- •Don't need a primary care doctor
- •No referrals needed for specialists
- •More flexibility, higher costs
HMO-POS (HMO Point-of-Service)
- •Combines HMO with some out-of-network coverage
- •Primary care doctor coordinates care
- •Can see out-of-network with referral
SNP (Special Needs Plan)
Medicare Advantage plans designed for people with specific conditions or circumstances. Three types are available:
- •D-SNP (Dual Eligible) — For individuals enrolled in both Medicare and Medicaid (or Medi-Cal in California). Plans coordinate benefits across both programs and often include extras like dental, vision, transportation, and reduced cost-sharing.
- •C-SNP (Chronic Condition) — For individuals with a qualifying chronic condition such as diabetes, chronic heart failure, cardiovascular disorders, ESRD, or chronic lung disorders. Plans offer tailored care management and specialized provider networks.
- •I-SNP (Institutional) — For individuals living in a nursing facility or who require institutional-level care. Plans focus on coordinated care for long-term medical needs.
Who is Eligible for Medicare Advantage?
To enroll in a Medicare Advantage plan, a person must first be eligible for Medicare itself and then meet four plan-specific requirements:
Have Medicare Part A and Part B
You must be enrolled in both Hospital Insurance (Part A) and Medical Insurance (Part B) before joining a Medicare Advantage plan.
Live in the plan’s service area
Plans are county-based and network-based. You must permanently reside in the county or state where the plan operates.
Be a U.S. citizen or lawfully present
You must be a U.S. citizen or lawfully present in the United States to qualify for Medicare and any Medicare Advantage plan.
Enroll during a valid period
You can only join, switch, or leave a Medicare Advantage plan during specific enrollment windows (see below).
Medicare Advantage Eligibility Requirements
You may qualify for a Medicare Advantage plan if you:
- Are enrolled in Medicare Part A and Part B
- Continue paying your Medicare Part B premium
- Live within the plan's service area
- Are a U.S. citizen or lawfully present in the United States
- Enroll during a valid Medicare enrollment period
2021 ESRD update
Historically, individuals with End-Stage Renal Disease faced restrictions joining Medicare Advantage plans. As of 2021, those restrictions were removed — people with ESRD can now generally enroll in Medicare Advantage plans if otherwise eligible.
Important: Medicare Advantage replaces — it doesn’t add
Medicare Advantage is not “extra insurance.” It replaces how a member receives Part A, Part B, and usually Part D benefits. The member is still in Medicare — but receives those benefits through a private insurance company contracted with CMS.
Find out if you may be eligible
Answer 4 quick questions — about 30 seconds. This is an educational guide, not a final determination.
When can I enroll?
You can join, switch, or leave a Medicare Advantage plan only during specific enrollment windows:
Initial Coverage Election Period (ICEP)
Your first chance to join a Medicare Advantage plan, usually around the time you first become eligible for Medicare at age 65.
Annual Enrollment Period (AEP)
October 15 – December 7 each year. Anyone with Medicare can join, switch, or drop a Medicare Advantage plan, with coverage starting January 1.
Medicare Advantage Open Enrollment Period (MA OEP)
January 1 – March 31. Only available to people already enrolled in a Medicare Advantage plan — switch to a different MA plan once or return to Original Medicare.
Special Enrollment Period (SEP)
Triggered by qualifying life events: moving, losing employer coverage, qualifying for Medicaid, gaining or losing Extra Help (LIS), natural disasters, plan termination, or a chronic condition diagnosis (for SNP eligibility).
Note: For the most current enrollment period details, visit Medicare.gov
Extra Benefits You May Get
Dental Coverage
Routine dental care, cleanings, and more
Vision Coverage
Eye exams, glasses, and contact lenses
Hearing Benefits
Hearing exams and hearing aids
Prescription Drugs
Part D prescription drug coverage included
Fitness Programs
Gym memberships and wellness programs
Over-the-Counter Benefits
Allowances for health-related items
Find Your Perfect Medicare Advantage Plan
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