Medicare Advantage Policy FAQs

Medicare Advantage provides the same coverage as Original Medicare plus additional benefits. Unlike Original Medicare, these plans often include:

• Prescription drug coverage
• Dental, vision, and hearing benefits
• Fitness and wellness programs
• Telehealth services
• Over‑the‑counter allowance
• Care coordination

Many plans also offer low or $0 monthly premiums and an annual out‑of‑pocket maximum, which Original Medicare does not provide.

Most plans include:

• Doctor visits and specialist care
• Hospital stays
• Emergency and urgent care
• Preventive services
• Prescription drugs (Part D)
• Dental cleanings, exams, and X‑rays
• Vision exams and eyewear allowances
• Hearing exams and hearing aid benefits
• Fitness memberships
• Telehealth services

Coverage varies by plan, so reviewing benefits is important.

Yes — most Medicare Advantage Plans include Part D prescription drug coverage, eliminating the need to purchase a separate drug plan.

Costs vary, but many plans offer:

• Low or $0 monthly premiums
• Predictable copays for doctor visits
• An annual out‑of‑pocket maximum for added financial protection

You must continue paying your Medicare Part B premium, even if your plan has a $0 premium.

You may qualify if:

• You are enrolled in Medicare Part A and Part B
• You live in the plan’s service area
• You do not have End‑Stage Renal Disease (with some exceptions)

You can enroll during:

• Annual Enrollment Period (AEP): October 15 – December 7
• Medicare Advantage Open Enrollment Period: January 1 – March 31
• Special Enrollment Periods: Triggered by life events such as moving, losing coverage, or changes in eligibility

It depends on the plan type:

• HMO plans: Require in‑network providers (except emergencies)
• PPO plans: Allow out‑of‑network providers at a higher cost
• PFFS plans: Let you see any provider who accepts the plan’s terms
• SNP plans: Designed for specific health or financial needs

Yes. Medicare regulates these plans, and they must meet strict federal standards. They are offered by private insurers that contract with Medicare to provide your benefits. 

Yes. Preventive services — such as annual wellness visits, vaccines, screenings, and mammograms — are covered at no additional cost when using in‑network providers.

Yes. You can switch during certain enrollment periods. You may also be able to add a Part D plan or apply for a Medicare Supplement (Medigap) policy, depending on eligibility.