Medicare Advantage Plans
Midwest Division Insurance Agency is here to help you weigh your Medicare coverage options. Medicare Advantage bundles your benefits into one convenient plan — often with $0 premiums and extra benefits Original Medicare doesn't cover.
What Is a Medicare Advantage (Part C) Plan?
Medicare Advantage (Part C) plans are a combined alternative to Original Medicare. Offered by private insurance companies approved by Medicare, these plans bundle your hospital, medical, and often prescription drug coverage into a single plan — sometimes with extra benefits like dental, vision, and hearing.
When you enroll in a Medicare Advantage plan, your Medicare benefits are managed through the plan rather than directly through Original Medicare. You're still part of the Medicare program and still pay your Part B premium, but your care is coordinated through your chosen plan.
As independent brokers, we compare Medicare Advantage plans from multiple carriers in your area — so you get the plan that truly fits your doctors, medications, and budget. Our guidance is always free.
Get Started with Medicare Enrollment
Not sure which plan fits your situation? We'll walk you through it step by step.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans, each with different rules for how you access care and which providers you can see. The right type depends on your preferences for flexibility vs. cost.
You must use doctors and hospitals within the plan's network for covered care, except in emergencies. Referrals are usually required to see specialists. HMOs typically offer the lowest premiums.
You can use in-network or out-of-network providers, but you'll pay more for out-of-network care. No referrals are required. PPOs offer more flexibility, usually at a slightly higher premium.
You may see any Medicare-approved provider who agrees to the plan's payment terms. PFFS plans have no network restrictions but providers must accept the plan's terms before treating you.
Designed for people with specific chronic conditions, dual Medicare/Medicaid eligibility, or those residing in certain care facilities. Benefits are tailored to the specific needs of the enrolled population.
Key Features: Medicare Advantage Plans
Here's what makes Medicare Advantage different from — and for many people, better than — Original Medicare alone.
Medicare Advantage Plan Types Compared
Here's how the four main plan types compare on the factors that matter most.
| Plan Type | Provider Access | Referrals Needed? | Out-of-Network Coverage | Includes Part D? |
|---|---|---|---|---|
| HMO | Must use plan network | Yes — for most specialists | No — except emergencies | Usually yes |
| PPO | In-network or out-of-network | No | Yes — at higher cost | Usually yes |
| PFFS | Any provider who accepts plan terms | No | Yes — provider must accept payment terms | Sometimes |
| SNP | Typically network-based | Often yes | Limited | Yes |
Choosing a Medicare Advantage Plan
The right plan depends on your individual healthcare needs, preferred providers, medications, and budget. Here are the key factors to evaluate — and we'll walk through all of them with you.
Enrolling in a Medicare Advantage Plan
You can join, switch, or drop a Medicare Advantage plan during specific enrollment windows. Here's when each one applies.
Medicare Advantage vs. Medigap
Both options add to your Original Medicare — but they work very differently. Here's a direct comparison to help you decide which approach fits your life.
| Feature | Medicare Advantage (Part C) | Medigap + Original Medicare |
|---|---|---|
| Replaces Original Medicare? | Yes — your care is managed through the plan | No — works alongside Original Medicare |
| Monthly premium | Often $0 or very low | Typically higher for Medigap policy |
| Includes Part D? | Usually yes — most plans include drug coverage | No — requires separate Part D plan |
| Provider flexibility | Limited — mostly network-based (HMO/PPO) | Any provider that accepts Medicare nationwide |
| Prior authorization | Common — often required for specialist services | Rarely required |
| Extra benefits (dental, vision, hearing) | Often included in many plans | Generally not included |
| Out-of-pocket maximum | Yes — annual cap on your costs | No hard max, but Medigap covers most gaps |
| Foreign travel emergency | Varies — many plans don't include it | Included in most Medigap plans |
*Both options require enrollment in Original Medicare Parts A and B.
Medicare Advantage FAQs
Can I switch from Original Medicare with Medigap to Medicare Advantage?
Yes. During the Annual Enrollment Period (October 15 – December 7), you can switch from Original Medicare with a Medigap plan to a Medicare Advantage plan. Keep in mind that if you later want to go back to Medigap, you may be subject to medical underwriting and could be denied or charged higher premiums based on your health history.
Are all Medicare Advantage plans the same?
No — Medicare Advantage plans vary significantly by carrier, location, network, benefits, and cost. Two plans with the same monthly premium can have very different drug formularies, provider networks, and extra benefits. That's why comparing plans side by side with a local expert makes a real difference.
Do Medicare Advantage plans include drug coverage?
Most Medicare Advantage plans include Part D prescription drug coverage (called MA-PD plans). However, some plans — particularly PFFS plans — do not include drug coverage. If you choose a plan without Part D, you may be able to add a standalone Part D plan depending on the plan type.
What happens if my Medicare Advantage plan leaves my area?
If your plan is discontinued or no longer serves your area, you'll receive advance notice and qualify for a Special Enrollment Period. You can switch to another Medicare Advantage plan or return to Original Medicare. We'll help you find a comparable replacement before your coverage ends.
Can I keep my current doctors with a Medicare Advantage plan?
It depends on the plan. Medicare Advantage plans use provider networks, and your current doctors may or may not be in-network. Before you enroll, we'll verify that your preferred doctors, specialists, and hospitals are covered so there are no surprises after you switch.