What Is Medicare Advantage? A Clear, Simple Guide

Justin Hundley
Jul 16, 2025
3 min read

If you're turning 65 or already on Medicare, you've probably heard the term Medicare Advantage—but what exactly is it, and how does it differ from traditional Medicare?

In this simple guide, we’ll explain what Medicare Advantage is, how it works, and whether it might be the right choice for you or a loved one.

💡 What Is Medicare Advantage?

Medicare Advantage (also known as Medicare Part C) is an all-in-one alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare.

When you enroll in a Medicare Advantage plan, your healthcare coverage is managed by the private insurer—not the federal government. But don’t worry, they still have to follow Medicare’s rules and cover everything Original Medicare does—and usually more.

🔍 What Do Medicare Advantage Plans Cover?

All Medicare Advantage plans must include:

✅ Everything covered by Medicare Part A (hospital insurance)

✅ Everything covered by Medicare Part B (doctor visits, outpatient care)

Some Medicare Advantage plans also include:

✅ Prescription drug coverage (Part D)

✅ Extra benefits like:

Vision and dental
Hearing aids
Over-the-counter items
Transportation to medical visits
Gym memberships or wellness programs

These extras are what make Medicare Advantage so attractive to many retirees.

Senior couple exploring Medicare Advantage plan options on a laptop — Many Medicare Advantage plans include dental, vision, and even prescription drug coverage—all in one simple plan.

🏥 How Does Medicare Advantage Work?

Instead of using Original Medicare, you’ll carry a Medicare Advantage insurance card from your private plan provider. You’ll typically get care from a network of doctors and hospitals, just like a group health plan.

Many plans are HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) structures:

HMO: You must use doctors in-network (except in emergencies) and may need referrals.
PPO: More flexibility to go out-of-network (but you’ll pay more).

💰 What Does It Cost?

One of the biggest perks of Medicare Advantage is affordability.

Most people:

Continue paying their Part B premium (usually $174.70/month in 2025)
Choose a $0 premium Medicare Advantage plan (yes, that’s a thing!)

Keep in mind:

You’ll still pay copays and coinsurance for services
Each plan has a yearly out-of-pocket maximum (Original Medicare does not)

🆚 Medicare Advantage vs. Original Medicare

Feature	Original Medicare	Medicare Advantage
Provider Network	Any doctor nationwide	Usually HMO/PPO network
Drug Coverage	Requires separate Part D plan	Usually included
Extra Benefits	Limited	Dental, vision, hearing, etc.
Monthly Premium	Part B + Medigap (optional)	Often just Part B
Out-of-Pocket Limit	No cap	Annual max (e.g., $8,850 in 2025)

🤔 Is Medicare Advantage Right for You?

Medicare Advantage might be a great fit if you:

Want affordable, all-in-one coverage
Prefer to manage everything under one plan
Need extra benefits like dental and vision
Are comfortable using a provider network

But if you:

Travel frequently
Want total freedom to see any doctor
Prefer a plan with no network restrictions

Then you may prefer sticking with Original Medicare + a Medigap supplement + Part D.

🧭 Need Help Comparing Medicare Advantage Plans?

At Mountaineer Health and Life Insurance, we help people across West Virginia, Virginia, Ohio, Kentucky, South Carolina, and Florida understand and enroll in the right Medicare coverage—at no cost to you.

We explain your options in plain English, compare top-rated plans, and make sure you get all the benefits you qualify for.