Medicare Advantage Plans — Find the Right Coverage With an Independent Broker

If you are approaching Medicare eligibility or looking to review your current coverage, Medicare Advantage is one of the most important options to understand. As an independent Medicare insurance broker serving clients across New York, New Jersey, and nationwide, I help seniors compare and enroll in Medicare Advantage plans every day with no bias toward any single carrier and no cost to you. Here is everything you need to know.

What Is Medicare Advantage?

Medicare Advantage — also known as Medicare Part C — is an alternative way to receive your Medicare benefits through a private insurance company approved by Medicare. Instead of using Original Medicare directly, you receive your Part A hospital coverage, Part B medical coverage, and usually Part D prescription drug coverage through a single Medicare Advantage plan.

Medicare Advantage plans must cover everything that Original Medicare covers except hospice care, which Original Medicare always covers. Many plans also offer valuable extra benefits not available through Original Medicare, such as dental, vision, hearing, fitness memberships, and transportation assistance.

Key Benefits of Medicare Advantage Plans

All-in-one coverage — combines Part A, Part B, and usually Part D into one convenient plan
Low or $0 monthly premiums — many plans have no additional monthly premium beyond your Part B premium
Annual out-of-pocket maximum — caps your total out-of-pocket spending each year. In 2026, the maximum is $9,350 for in-network services
Extra benefits — dental, vision, hearing, fitness memberships, over-the-counter allowances, and transportation to medical appointments
Prescription drug coverage — most plans include Part D drug coverage
Coordinated care — many plans offer care coordination services to help manage chronic conditions

Types of Medicare Advantage Plans

Medicare Advantage plans come in several types, each with a different approach to networks, costs, and flexibility. Here is an overview:

Health Maintenance Organization (HMO) Plans

Medicare Advantage HMO plans require you to use a network of doctors, hospitals, and other healthcare providers. You will typically need to choose a primary care physician and get referrals to see specialists. HMO plans generally have lower monthly premiums and out-of-pocket costs in exchange for these network restrictions.

Preferred Provider Organization (PPO) Plans

Medicare Advantage PPO plans offer more flexibility than HMOs. You can see any doctor or specialist in-network or out-of-network without a referral, though you will pay less when you stay in-network. PPO plans typically have higher premiums than HMO plans in exchange for that flexibility.

Special Needs Plans (SNPs)

Special Needs Plans provide focused and specialized healthcare for specific groups of people, including those who have both Medicare and Medicaid (dual-eligible), live in a nursing home, or have certain chronic medical conditions such as diabetes, heart disease, or COPD. SNPs tailor their benefits and provider networks to the specific needs of their target population.

Private Fee-for-Service (PFFS) Plans

PFFS plans allow you to see any doctor or hospital that accepts the plan’s payment terms, similar to Original Medicare. The plan determines how much it will pay providers and how much you pay when you receive care.

HMO Point-of-Service (HMO-POS) Plans

HMO-POS plans are a hybrid; they function like an HMO for most services but allow you to go out-of-network for certain services at a higher cost. This offers slightly more flexibility than a standard HMO while keeping premiums relatively low.

Medical Savings Account (MSA) Plans

Medicare MSA plans combine a high-deductible health plan with a medical savings account. Medicare deposits money into the account, which you can use to pay for healthcare services before meeting your deductible.

How Much Do Medicare Advantage Plans Cost?

Medicare Advantage plan costs vary significantly by plan type, carrier, and location. Here is what to expect in 2026:

Monthly premium: Many plans have a $0 monthly premium — though you still pay your Medicare Part B premium of $202.90/month
Annual out-of-pocket maximum: Up to $9,350 for in-network services in 2026 — after which the plan pays 100% of covered costs
Copays and coinsurance: You pay copays or coinsurance for each service — doctor visits, specialist visits, hospital stays, etc.
Prescription drug costs: Vary by plan formulary and the tier of your medications

Because plan costs vary so significantly from carrier to carrier and region to region, comparing plans side by side is essential. As an independent broker, I do this comparison work for you across all major carriers at no cost to you.

Medicare Advantage vs Medicare Supplement — Which Is Right for You?

This is one of the most common questions I help clients answer. Here is a simple comparison:

Medicare Advantage — replaces Original Medicare, typically with a $0 or low monthly premium, network restrictions, copays per service, includes drug coverage, and extra benefits
Medicare Supplement (Medigap) — works alongside Original Medicare, higher monthly premium, freedom to see any Medicare-accepting doctor nationwide, very predictable out-of-pocket costs

The right choice depends on your health needs, preferred doctors, budget, and lifestyle. I help clients evaluate both options objectively — with no pressure toward any particular plan type or carrier.

Who Is Eligible for Medicare Advantage?

To enroll in a Medicare Advantage plan, you must:

Be enrolled in both Medicare Part A and Part B
Live in the plan’s service area
Not have End-Stage Renal Disease (ESRD) in most cases, though rules have changed, and some plans now accept ESRD patients

When Can You Enroll in Medicare Advantage?

Initial Enrollment Period (IEP): When you first become eligible for Medicare, a 7-month window around your 65th birthday
Annual Enrollment Period (AEP): October 15 – December 7 each year — changes take effect January 1
Medicare Advantage Open Enrollment Period: January 1 – March 31 — switch plans or return to Original Medicare
Special Enrollment Period (SEP): Triggered by qualifying life events such as losing employer coverage or moving

Frequently Asked Questions — Medicare Advantage Plans

Do Medicare Advantage plans cover prescription drugs?

Most Medicare Advantage plans include Part D prescription drug coverage as part of the plan. Before enrolling, always verify that your specific medications are covered on the plan’s formulary at an acceptable cost.

Can I keep my current doctors with a Medicare Advantage plan?

It depends on the plan. HMO plans require you to use in-network providers. PPO plans allow out-of-network care at a higher cost. Before recommending any plan, I always verify that your preferred doctors and hospital systems are included in the network.

Can I switch from Medicare Advantage back to Original Medicare?

Yes — during the Annual Enrollment Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31), you can switch back to Original Medicare. Keep in mind that if you want to add a Medigap plan after returning to Original Medicare, you may need to pass medical underwriting, depending on your state.

Is it free to use a Medicare broker to compare Advantage plans?

Yes — completely free. Independent Medicare brokers like Craig Smith are compensated by insurance carriers, not clients. You get expert plan comparison and enrollment guidance at no cost to you.

Get Your Free Medicare Advantage Consultation

As an independent Medicare broker appointed with all major carriers, including UnitedHealthcare/AARP, Aetna, Humana, Anthem/Empire, and more, I compare Medicare Advantage plans across the entire market to find the plan that genuinely fits your health needs and budget.

I serve clients across New York, New Jersey, and nationwide — by phone, video, or in person completely free of charge.

📞 Contact Craig Smith Insurance Group today at (917) 740-1895 for your free Medicare Advantage consultation. No pressure, no obligation, just straightforward guidance from an independent broker who genuinely cares about getting you the right coverage.