Medicare Advantage

Medicare Advantage, also called Medicare Part C, is a way to receive your Medicare benefits through a private insurance company instead of directly from the federal government. The plan bundles Part A and Part B into one product, and most versions include prescription drug coverage as well.

Many Medicare Advantage plans charge a $0 monthly plan premium, though you still pay your Part B premium. Plans commonly add benefits Original Medicare doesn't cover, such as dental, vision, hearing, fitness memberships, and transportation to appointments.

The tradeoff is network restriction. Original Medicare is accepted by nearly any provider nationwide with no referrals required. Medicare Advantage plans operate as HMOs or PPOs with defined networks, and often require referrals to see specialists and prior authorization for certain procedures.

One meaningful advantage: Medicare Advantage plans include an annual out-of-pocket maximum. Original Medicare has none, which is why many people on Original Medicare buy a separate Medigap policy for protection.

Why this matters before 65. If you're on a Marketplace plan now and approaching Medicare eligibility, the transition needs planning. Your Marketplace subsidy generally ends when Medicare eligibility begins, and the choice between Original Medicare with Medigap versus Medicare Advantage is easier to make before you age in than after. Medigap has medical underwriting outside your initial enrollment window in most states, which means switching later can be difficult or expensive.

Wise Health Choices specializes in under-65 ACA coverage rather than Medicare plans, so for Medicare-specific enrollment we'll point you to your State Health Insurance Assistance Program (SHIP) for free unbiased counseling.