Medicare Advantage Plans: How to Get More Coverage for Less
Updated: Sep 13, 2025
Navigating Medicare can feel overwhelming, especially when you’re deciding between Original Medicare and Medicare Advantage. Learn how Medicare Advantage plans work, what makes them different from traditional Medicare, and how they can sometimes give you more coverage at a lower out-of-pocket cost.
Understanding Original Medicare
Original Medicare is the traditional federal health insurance program for people age 65 and older (and some younger individuals with certain disabilities). It includes:
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Part A – Hospital insurance, covering inpatient hospital stays, skilled nursing facilities, hospice care, and some home health services.
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Part B – Medical insurance, covering doctor visits, outpatient care, preventive services, and medical supplies.
While Original Medicare covers a lot, it doesn’t include prescription drugs (unless you add a separate Part D plan) and doesn’t cap your annual out-of-pocket costs. You can buy supplemental coverage (Medigap) to help fill those gaps, but that comes with an additional monthly premium.
What Medicare Advantage Adds
Medicare Advantage, also called Part C, is offered by private insurance companies approved by Medicare. These plans bundle your Part A and Part B benefits and often include extras that Original Medicare doesn’t cover—like prescription drug coverage, vision, dental, hearing, and wellness programs.
In many cases, Medicare Advantage plans also set a maximum annual out-of-pocket limit, which can protect you from very high medical costs.
How Medicare Advantage Works
When you enroll in a Medicare Advantage plan, you still have Medicare—it’s just administered through the private insurer rather than directly by the federal government. You’ll pay your regular Part B premium, plus any premium the plan itself charges (many have $0 premiums).
Plans usually operate like HMOs or PPOs, meaning you’ll have a network of doctors and hospitals. Some require you to choose a primary care doctor and get referrals for specialists.
Comparing Costs: Medicare vs. Medicare Advantage
One of the main reasons people choose Medicare Advantage is cost predictability. While Original Medicare can leave you paying 20% of most services with no annual cap, Medicare Advantage plans limit your total yearly out-of-pocket expenses.
However, the trade-off is flexibility. Original Medicare allows you to see any provider who accepts Medicare nationwide, while most Medicare Advantage plans have smaller, regional networks. If you travel frequently or live in multiple states during the year, this could be a deciding factor.
Prescription Drug Coverage
Most Medicare Advantage plans include prescription drug coverage (Part D) as part of the package, so you don’t need a separate plan. With Original Medicare, you must purchase a standalone Part D plan if you want drug coverage, which means shopping and paying for another policy.
The downside is that each Medicare Advantage plan has its own drug formulary (list of covered medications), so it’s important to check whether your prescriptions are included before enrolling.
Extra Benefits You Won’t Get with Original Medicare
Many Medicare Advantage plans include services that aren’t covered at all under Original Medicare, such as:
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Vision exams and eyewear allowances
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Dental cleanings and procedures
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Hearing aids and exams
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Gym memberships or fitness programs
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Over-the-counter health products
While these extras can be valuable, not everyone needs them—so they shouldn’t be the only reason you choose a plan.
How to Choose the Right Option for You
Start by comparing your healthcare needs, budget, and lifestyle:
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If you want nationwide provider flexibility and don’t mind paying extra for Medigap and Part D, Original Medicare might be better.
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If you want lower monthly costs, a spending cap, and built-in extras, Medicare Advantage may be the smarter choice.
Use the official Medicare Plan Finder to compare costs, coverage, and provider networks side by side. Look at the plan’s star rating, which reflects quality and customer satisfaction.
Enrollment Periods to Know
You can join, switch, or drop a Medicare Advantage plan during:
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Initial Enrollment Period – When you first qualify for Medicare.
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Annual Enrollment Period (Oct 15–Dec 7) – Change between Original Medicare and Medicare Advantage or switch plans.
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Medicare Advantage Open Enrollment (Jan 1–Mar 31) – Switch to a different Medicare Advantage plan or go back to Original Medicare.
Outside these periods, changes are only allowed in certain circumstances, like moving to a new service area.
Final Thoughts
Medicare Advantage plans can be a cost-effective way to get more coverage than Original Medicare, especially if you value extra benefits and a predictable annual spending limit. But the trade-offs in provider choice and regional network limits mean it’s worth comparing carefully before making a decision. The right choice comes down to your healthcare needs, travel habits, and how much you value flexibility versus savings.
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