Why Should I Choose a Medicare Advantage Plan?
A Medicare Advantage (Part C) plan can give you benefits Original Medicare doesn’t offer.
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Medicare Advantage is an all-in-one health insurance option for anyone eligible for Medicare.
Medicare Advantage, also known as Part C, includes Original Medicare coverage. It also offers additional benefits that are not available through Original Medicare.
You can get those Medicare Advantage benefits for little to no monthly premium above what you already pay for Original Medicare. Medicare Advantage is available through private insurers, like HealthSpring.
That could be why a majority of Americans eligible for Medicare get their coverage through a Medicare Advantage plan. About 51% of Medicare-eligible Americans are in an MA plan, a number that’s gone up every year since 2013.1
Here’s some more information that will help you decide if Medicare Advantage is right for you.
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What Are the Benefits of Medicare Advantage?
Every Medicare Advantage plan must cover what Original Medicare does. Many plans go further, offering extra benefits that matter to your health and wellness.
Here’s what a Medicare Advantage plan may include:
Original Medicare: Parts A (hospital) and Part B (medical)
Prescription drug coverage
Health benefits not offered by Medicare, such as vision, dental and hearing
Extra benefits such as meal delivery, fitness center membership and transportation to your doctor’s office
Part B giveback, a monthly reduction to your Medicare Part B premium
Maximum limit on out-of-pocket costs
How Does Medicare Advantage Differ from Original Medicare?
Here is how Medicare Advantage and Original Medicare compare in their benefits:
|
Benefit
|
Original Medicare
|
Medicare Advantage
|
|---|---|---|
|
Hospital and medical
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Included
|
Included
|
|
Prescription drugs
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None; must enroll in a standalone Part D plan to get coverage
|
Most plans include prescription drug coverage
|
|
Dental
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Does not cover routine dental care
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Many plans include routine dental care, cleanings, X-rays, fillings, and in some cases, dentures or implants
|
|
Vision
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Eye exams related to medical screenings. No routine eye care
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Many plans include routine eye exams, eyeglass frames and contact lens allowances
|
|
Hearing
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Routine hearing exams and hearing aids are not covered
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Many plans include coverage of hearing exams and hearing aids
|
|
Fitness and wellness programs
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Generally not covered
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Many plans include free or reduced-priced gym memberships, fitness programs and wellness programs |
|
Transportation
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Generally not covered
|
Some plans cover non-emergency transportation to provider visits, labs and pharmacies
|
|
Over-the-counter drug allowances
|
Generally not covered
|
Some plans include coverage for certain over-the-counter drugs
|
Not all Medicare Advantage plans offer the same benefits. There are many options to choose from based on what coverage you want. Want to explore HealthSpring Medicare Advantage plans in your area? We can help.
How Much Does Medicare Advantage Cost?
Before talking about costs, here’s a few key terms to know:
Premium: The monthly amount you pay to keep your coverage active.
Deductible: The amount you pay out of pocket before Medicare begins paying its share.
Coinsurance: The percentage of covered costs you pay after the deductible is met. For example, you may pay 20% of a service’s approved cost under certain parts of Medicare (often called the 80/20 rule).
Penalty: A fee added to your premium if you delay enrollment or don’t meet certain coverage requirements.
Copay: A fixed, flat fee you pay out-of-pocket for a specific health service or prescription at the time you receive care.
Out-of-pocket Maximum: The most money you’ll have to pay in a plan year before insurance covers 100% of all costs.
Plan allowance: The maximum dollar amount a health plan agrees to pay a doctor or hospital
In-network: Refers to any doctor, hospital, pharmacy or health facility that has a signed contract with your insurer to accept their rates.
Out-of-network: Refers to any doctor, hospital, pharmacy or health facility that doesn’t have a signed contract with your insurer to accept their rates. Usually, you pay extra out-of-pocket costs to see an out-of-network provider, except in emergencies.
To enroll in a Medicare Advantage Plan, you must be eligible for and enrolled in Original Medicare Parts A and B and live within the plan's service area. You must continue to pay your Part B premium.
However, many Medicare Advantage plans are available for no additional charge. That includes plans with prescription drug coverage. Some Medicare Advantage plans even include what’s called a Part B giveback. That means your plan covers a portion of your Plan B premium.
Coinsurance and deductibles vary in Medicare Advantage plans, so it’s best to compare plans to find the right meet for your health needs. Like most private plans, each Medicare Advantage has a network of providers, hospitals, pharmacies and facilities. Any out-of-network care, except in emergencies, might not be covered.
Unlike Original Medicare, Medicare Advantage plans have a maximum out-of-pocket cost cap for approved services. That gives you predictability and certainty over your health care spending.
How Is My Care Coordinated under Medicare Advantage?
Medicare Advantage plans often include care coordination features that help manage chronic conditions and prevent gaps in care. This is particularly the case with HMO plans.
Members with various chronic conditions may qualify for one of our care management programs. A dedicated care manager can help coordinate care, review your medication and therapies, and help find community resources and education. Disease management helps customers with conditions such as chronic kidney disease, cancer and diabetes. Visit the HealthSpring Medicare resources page to learn more about what care managers do and if you qualify.
Some Medicare Advantage plans require you to choose a primary care physician, who coordinates referrals, follow-ups and specialist care. The primary care physician must be part of your Medicare Advantage plan’s network.
Many Medicare Advantage plans have other care coordination benefits, such as:
Disease management programs
Nurse hotlines
Telehealth services
All these benefits in Medicare Advantage can help create a care experience that feels connected.
Is a Medicare Advantage Plan Right for Me?
It’s worth taking some time to consider your care needs and then comparing Medicare Advantage and Original Medicare plans. HealthSpring offers flexible plan options to support a variety of needs. To compare HealthSpring Medicare Advantage plans, confirm if your provider is in-network, or see estimated costs, use our online tool or call us at
How Do Original Medicare and Medicare Advantage Compare?
In summary, these are notable differences between Medicare Advantage and Original Medicare plans:
|
Original Medicare
|
Medicare Advantage
|
|
|---|---|---|
|
Extra benefits (dental, vision, hearing)
|
No
|
Yes
|
|
Prescription drug coverage
|
No
|
Yes, in many plans
|
|
Out-of-pocket maximum cost
|
No
|
Yes
|
|
Monthly premium
|
Yes (covers Medicare Part B)
|
Yes (covers Medicare Part B plus a no-to-low-cost charge for extra services); plan might allow Part B giveback |
|
Provider network
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Anyone who contracts with Original Medicare
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Anyone who contracts with your Medicare Advantage plan
|
The right choice for you depends on your health needs, your budget, and your desired provider.
Frequently Asked Questions
What are the biggest benefits of Medicare Advantage?
Medicare Advantage plans often include extra benefits not covered by Original Medicare, such as dental, vision, hearing and fitness programs. Most plans also bundle prescription drug coverage and cap annual out-of-pocket costs, providing both broader coverage and financial protection in a single plan.
Is Medicare Advantage better than Original Medicare?
Most Medicare Advantage plans require you to use doctors and hospitals within their network. HMO plans may require referrals to see specialists.
Beneficiaries who travel frequently or prefer to see any provider without restrictions may find Original Medicare paired with a Medigap plan or a Medicare Prescription Drug Plan to be a better fit. HealthSpring offers Medicare Supplement (Medigap) and standalone Medicare Prescription Drug plans.
Do Medicare Advantage plans cover dental and vision?
Many Medicare Advantage plans include routine dental and vision coverage. Original Medicare doesn’t provide that coverage. Dental benefits may include cleanings, X-rays, and fillings, while vision benefits often cover annual eye exams and an allowance for eyeglasses or contacts. Specific benefits vary by plan and location.
Does Medicare Advantage include prescription drug coverage?
Most Medicare Advantage plans include Part D prescription drug coverage. That means you don’t need a separate drug plan. The lists of covered drugs, also called the formulary, varies by plan. It’s important to confirm that your specific medications are covered before enrolling.
Is there an out-of-pocket maximum with Medicare Advantage?
Yes. Medicare Advantage plans are required by law to include an annual out-of-pocket maximum for covered services. Once you reach that limit, the plan covers 100% of your covered costs for the remainder of the year. Original Medicare does not have this built-in protection.
What is Part B giveback?
The “Part B giveback” is a benefit available in some Medicare Advantage plans. Under the part B giveback, your Medicare Advantage plan would cover part of your required monthly Part B premium. HealthSpring’s Part B giveback is simple. HealthSpring sends your giveback to Social Security, which then automatically reduces the total you owe on your Part B premium.
You don’t have to send a check. And you don’t have to wait for a check in the mail.
When can I enroll in Medicare Advantage?
There are three enrollment periods for Medicare Advantage:
Initial enrollment period (IEP): A 7-month window when you can first sign up for Original Medicare, Medicare Advantage, or prescription drug coverage without facing late penalties. That window is three months before your 65th birthday, your 65th birthday month, and three months after your 65th birthday.
Annual enrollment period: Between October 15 and December 7, if you wish to change Medicare plans. For example, you could switch from Original Medicare to Medicare Advantage, or switch from one Medicare Advantage Care plan to another. Changes go into effect the following January 1.
Open enrollment period: If you’re already in a Medicare Advantage plan, between January 1 and March 31, you may use this period to switch plans. Changes go into effect on the first day of the month after your plan receives your request.
What’s the difference between a Medicare Advantage HMO and PPO?
An HMO plan typically comes with lower costs, but requires you to see providers within a network and get referrals before you see a specialist.
A PPO plan typically costs more, but offers more flexible options for seeing providers and may not require any referrals to see specialists.
What is a Medicare Advantage Special Needs Plan?
Special Needs Plans help customers with specific diseases, certain health care needs or those who also have Medicaid. Learn more about Special Needs Plans and some of the services that come with SNPs.
1Medicare Enrollment Dashboard, Centers for Medicare and Medicaid Services, data current as of May 2026.