Medicare Advantage

What is Medicare Advantage?

Medicare Advantage is an alternative way to get Medicare benefits through private insurance companies instead of accessing traditional Medicare, which is usually done through the US government’s Social Security Administration website or via a licensed Medicare insurance agent.

How does Medicare Advantage work?

Medicare pays private insurance companies (like Humana, Aetna, or UnitedHealthcare) to provide your Medicare benefits. You still have Medicare, but get coverage through the private plan rather than directly from the government.

What's typically included:

• All the same benefits as traditional Medicare (Parts A and B)
• Often provides prescription drug coverage (Part D) built in
• Many plans add extra benefits like dental, vision, hearing aids, or wellness programs
• Some include transportation to medical appointments, and other additional benefits

Key differences from traditional Medicare:

• You must use doctors and hospitals in the plan's network (like employer health insurance)
• You need referrals to see specialists in most plans
• Costs are more predictable - there are often lower monthly premiums, but with annual out-of-pocket limits
• Plans can change their coverage and costs each year
• Has a maximum out-of-pocket limit (unlike Original Medicare, Medicare Advantage caps your yearly expenses, meaning once you hit a certain amount, services are fully covered for the rest of the year)
• Uses a different cost structure (Instead of Medicare's standard deductibles and coinsurance, Medicare Advantage plans set their own premiums, copays, and deductibles)

The bottom line: Medicare Advantage can save money and provide extra benefits, but trades some of traditional Medicare's flexibility for lower costs and additional services. It works well for people who don't mind staying within a network and want predictable costs.
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You can only enroll or make changes during specific times each year, primarily during the Medicare Advantage Annual Enrollment Period (October 15 - December 7).

What’s Covered Under Medicare Advantage?

With Medicare Advantage, seniors get comprehensive coverage that typically includes:

Core Medicare Benefits (required in all plans):

• Hospital coverage (Medicare Part A)
• Medical services and doctor visits (Medicare Part B)
• Emergency and urgent care
• Lab tests and diagnostic services
• Preventive care, like annual wellness visits and screenings

Usually Included:

• Prescription drug coverage (Part D) - Most Medicare Advantage plans include this built-in
• Annual out-of-pocket maximum - Traditional Medicare doesn't have this protection

Common Extra Benefits (varies by plan):

• Dental coverage - Often routine cleanings, sometimes major dental work
• Vision coverage - Eye exams, glasses, sometimes contacts
• Hearing aids - Discounts or coverage for hearing devices
• Transportation - Rides to medical appointments
• Fitness programs - Gym memberships or fitness classes
• Wellness programs - Health coaching, disease management
• Telehealth services - Virtual doctor visits
• Over-the-counter allowances - Monthly credits for pharmacy items

Some Plans May Include:

• Limited dental implants or major dental work
• Meal delivery after hospital stays
• Home health services
• Medical alert devices
• Podiatry care
• Acupuncture or chiropractic care

What They Don't Get:

• Complete freedom to see any Medicare provider (must stay in network)
• Automatic coverage when traveling outside the plan's service area
• The same provider access as traditional Medicare
• Guaranteed plan stability (benefits can change annually)

The bottom line: Medicare Advantage can save money and provide extra benefits, but trades some of traditional Medicare's flexibility for lower costs and additional services. It works well for people who don't mind staying within a network and want predictable costs.
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You can only enroll or make changes during specific times each year, primarily during the Medicare Advantage Annual Enrollment Period (October 15 - December 7).

Coverage Limitations

Long-Term Care Services:

• Nursing home care (except during Medicare-covered skilled nursing facility stays).
• Custodial care, including light housekeeping, laundry, and meal preparation, when it's the only care needed.
• Personal care, including help with bathing, dressing, and eating, when it's the only care needed.
• Medicare Interactive has more information about items and services excluded from Medicare coverage.

Dental and Vision Care:

• Routine vision care, such as eye exams and corrective lenses, is generally excluded unless it is offered as a supplemental benefit.
• Perhaps one of the most frequent exclusions from Medicare Advantage Plans is coverage for dental services.
• Note: Some plans do offer basic dental and vision as supplemental benefits.

Alternative and Experimental Medicine:

• Alternative medicine including experimental procedures and treatments, acupuncture, and chiropractic services.
• Acupuncture is typically excluded from Medicare Advantage Plan coverage, with most plans classifying it as an alternative treatment.
• Routine costs for clinical trials are not covered services under Medicare Advantage Plans.

Hearing Services:

• Hearing aids, including examinations for prescribing or fitting hearing aids
• Hearing is typically excluded from Medicare coverage

International Travel:

• Coverage is typically limited to a specific dollar amount or a specified number of days corresponding to the trip.
• Medicare only covers medical care outside of the United States in rare, emergency circumstances

There are several Medicare Advantage enrollment periods throughout the year. Each enrollment period has different rules regarding who can enroll and what changes are allowed. We break down the key dates and deadlines you need to be aware of.

Enrollment Periods

• Medicare Advantage Annual Enrollment Period: October 15 - December 7
• Who can use it: Everyone with Medicare
• Medicare Advantage Open Enrollment Period: January 1 - March 31
• Initial Enrollment Period: 3 months before the month you turn 65, and 3 months after (7-month window)
• Special Medicare Advantage Enrollment Periods (varies by circumstance)
• Plan Information Release - October 1

You can find more details on individual periods by clicking the links above or all enrollment periods in our Medicare Advantage Enrollment Periods page.

Enrollment Planning

September/Early October

• Review your current plan's Annual Notice of Change (ANOC)
• Compare Medicare Advantage plans for the upcoming year
• Check if your doctors/medications are still covered

Late December

• Deadline to make changes during open enrollment
• Ensure your enrollment is processed before January 1

Throughout the Year

• Monitor for Special Enrollment Period triggers
• Keep track of plan changes or provider network updates

Pro Tip: Even if you're satisfied with your current plan, it's wise to review your options annually during the October-December open enrollment period, as plan benefits, costs, and provider networks can change each year.

What are Medicare Advantage Star Ratings?

Medicare Advantage Star Ratings are quality scores assigned by the government to Medicare Advantage plans each year, helping seniors evaluate and compare Medicare Advantage plans.

• The ratings are given on a 1 to 5-star scale (with 5 being the best/highest rating)
• Centers for Medicare & Medicaid Services (CMS) collects data on Medicare Advantage plans from member surveys, the plans themselves, and from medical providers.
• It then assigns a star rating based on those results.

The ratings evaluate plans on things like:

• How well they manage chronic conditions like diabetes
• Customer service and member experience
• How easy it is to get care and appointments
• Preventive care (screenings, vaccines, etc.)
• Prescription drug coverage and costs
• Overall member satisfaction

See the best Medicare Advantage plans in 2025 and compare them based on what matters most to you. 

How to Use Ratings

• Higher-rated plans generally correlate with providing better service and care coordination
• Seniors can compare star ratings when comparing plans
• Star ratings of four or higher are extremely valuable to health insurance companies
• Plans with higher ratings get bonus money from the government, which they often pass on to customers as better benefits or lower costs
• Look for plans with higher ratings when you compare Medicare Advantage plans, but don't use ratings as your only factor - also consider costs, provider networks, and covered benefits
• Check year-over-year plan rating changes - take note of plans that have gone down significantly
• Be aware that new or unrated plans may lack sufficient data for a rating; however, they may still offer competitive benefits or lower costs.

When are Medicare Advantage Star Ratings released?

CMS releases the latest Medicare Advantage plan star ratings on Thursdays in early to mid-October each fall. In 2024, this was on October 10th, 2024. These ratings are essential for evaluating plan quality before open enrollment.

Comprehensive non-governmental Medicare Advantage resources are available, including plan comparison tools, state and local resource locators, information on Medicare Advantage enrollment periods, and details on costs and coverage.

• Medicare.gov has provided an official guide called Understanding Medicare Advantage Plans.. 
• You can also find the entire US government handbook, called Medicare & You 2025 which is 128 pages of Medicare details. 
• Seniors Reports daily news is an excellent source of information and current news on Medicare, Medicare Advantage, and many other relevant topics on aging and senior living.