The other way to cover the 20%
How does a Medicare Advantage plan work?
An Advantage plan bundles your Medicare, your prescriptions and some extras into one plan with a low monthly cost. You pay as you use it, and there's a limit on what a bad year can cost you.
These are the plans you'll see called HMO or PPO.
Don't know a word? Press any purple word to see what it means. They're all listed at the bottom of the page.
Meet Linda
A short story. It stops before the ending.
Read the script
The one picture to remember
Four things in one plan, and a ceiling on the year.
How it works
Six short cards. Open "Going deeper" only if you want the detail.
One plan does the whole job
Instead of Medicare paying 80% and a second plan filling the gap, an Advantage plan takes over the job. You keep Medicare, and a private company delivers it — plus your prescriptions and some dental, vision and hearing coverage.
That's why the monthly cost is low. It's the trade for how you pay later.
The monthly cost is the low part
A plan with no monthly cost isn't free coverage. It means the cost arrives when you use it.
You pay copays when you use it
A copay is a set amount you pay for a visit, a test or a stay. Instead of one predictable monthly bill, your cost tracks how much care you actually need.
Every plan sets its own amounts, and they differ by county. The plan finder on this site shows the real figures for the plans where you live.
The big things are where the copays add up
Everyday care is cheap. A surgery, a hospital stay or cancer treatment is where a per-day hospital copay and a string of tests turn into real money — at the same moment you're least able to deal with it.
That's the honest gap in these plans: you pay less up front, and if you actually end up using your coverage a lot, you come out of pocket more.
There's a limit on what one year can cost you
Every Advantage plan has a yearly maximum. Once your copays reach it, the plan covers the rest of the year at 100%.
This matters because Original Medicare on its own has no limit at all (step 1). A limit is real protection — and it's also real money you could be asked for in a bad year.
These plans use networks, and come as HMO or PPO
So before you pick one, the question is simple: are your doctors in it? Check your own doctors and prescriptions here — nothing is saved.
Going deeper — prior approval
Advantage plans can require the plan's approval before certain care goes ahead — scans, surgeries, rehab stays. Your doctor asks the plan first. Approvals are common, but it's a step Original Medicare with a Supplement doesn't have.
It's the difference people notice most after a serious diagnosis, so it's worth asking about.
These plans can change each year
Copays, the yearly maximum, the extras, the network and the drug list can all change for the coming year. Your plan mails you a notice each fall showing what's different.
It's worth reading. The plan that fit you this year may not be the right fit next year, and fall is when you can change it.
Some dental, vision and hearing — with limits
Most Advantage plans include some coverage for dental, vision and hearing, which Original Medicare doesn't cover at all. Plans may also include things like gym access or an over-the-counter allowance.
Read these as a bonus, not full coverage: each one usually has a yearly dollar allowance, and a big dental job can use it up quickly.
Try it
Two quick tools. Nothing you pick is saved.
Add up a year of care
Tap the plus and minus to build a year, and watch what you'd pay.
Well under this example plan's $6,000 yearly maximum.
Example amounts on an example plan, to show how copays stack up — not a real plan.
Copays and the yearly maximum are set plan by plan, county by county. See the plans in your area yourself, or have a licensed support agent go through them with you.
No obligation. You can request help from one of our licensed support agents at any time.Which one sounds like you?
No score, no right answer. Just tap the one that fits.
Tap one to see what it usually means.
How Linda's story ends
A year with one big thing in it.
Read the script
- Cost her very little every month for the four quiet years before this one.
- Included her prescriptions and some dental in the same plan.
- Stopped the bleeding once she reached the yearly maximum — the rest of the year was covered.
- A real bill in the year she needed care, built from copays rather than one premium.
- Staying inside the network, and getting approvals before some of it went ahead.
You're going to pay for your coverage one way or the other. Either more each month and you're covered when you use it, or less each month and more out of pocket if something major happens.
How Hunter puts it on a callWords on this page
- Copay
- A flat amount you hand over at the visit. Twenty dollars to see your doctor, for example.
- Network
- The doctors and hospitals a plan has a deal with. Going outside it costs more, or is not covered at all.