Why people choose Advantage

• Copays instead of 20% coinsurance on many services.
• An annual out-of-pocket maximum (MOOP) that Original Medicare doesn’t have.
• Often includes Part D prescription drug coverage.
• Extras on many plans: dental, vision, hearing, gym, over-the-counter allowance, transportation.

Trade-offs to understand

• Networks: HMOs require in-network care (referrals likely). PPOs allow out-of-network at higher cost.
• Usage-based costs: Copays and coinsurance vary by service and plan.
• Moving matters: Plan options and networks change by county.

What’s typically included

• All Part A (hospital) and Part B (medical) benefits.
• Most plans bundle Part D drug coverage.
• Preventive care, telehealth, disease management programs.
• Many plans add dental, vision, hearing, fitness, OTC allowances (plan-specific).

Costs, simply explained

• Monthly premium: Some plans are $0; you still pay your Part B premium.
• Copays/coinsurance: For office visits, hospital stays, labs, imaging, ER, etc.
• MOOP: Your annual out-of-pocket ceiling for Part A/B services under the plan.
• Drugs: Tiered copays; check your medications and pharmacy for best pricing.

HMO vs PPO (quick take)

• HMO: Lower costs, in-network only (except emergencies); referrals often required.
• PPO: Higher flexibility; out-of-network allowed but costs more; referrals not usually required.

When you can enroll

• IEP: Around your 65th birthday.
• AEP: Oct 15 – Dec 7 (changes start Jan 1).
• OEP: Jan 1 – Mar 31 (switch Advantage plans or go back to Original Medicare).
• SEPs: For qualifying life events (move, loss of coverage, Extra Help/Medicaid, etc.).

See enrollment windows

How to pick a plan (5-step checklist)

1. List your doctors and preferred hospital/clinic.
2. List your medications and dosages + preferred pharmacy.
3. Estimate typical care: visits, tests, therapies, procedures you expect.
4. Decide your tolerance for HMO vs PPO trade-offs.
5. Compare MOOP, copays, and drug costs—not just premium.

FAQ

• Can I keep my doctor? Only if they’re in your plan’s network (PPOs may allow out-of-network at higher cost).
• What is MOOP? The most you’ll pay for Part A/B services in a year under the plan; after that, the plan pays 100%.
• Does it include drugs? Most Advantage plans do; verify your meds and pharmacy for pricing.
• Are dental/vision included? Often, but amounts and limits vary by plan.
• Do I need referrals? Often for HMOs, usually not for PPOs.
• What about travel? Emergency/urgent care is covered; routine care outside your network usually isn’t (check PPO rules).
• What are Star Ratings? CMS quality scores (1–5 stars) that reflect plan performance and member experience.
• Can I switch later? Yes during AEP; limited options in OEP; SEPs for certain life events.