Discover the top 5 benefits of Medicare Advantage

Curious about the benefits of Medicare Advantage?

If you’re turning 65 or you’re already enrolled in Medicare, you’ve likely come across Medicare Advantage plans.

• Fun fact: An estimated 54% of Medicare beneficiaries enroll in Medicare Advantage plans.¹
• More fun facts: The average Medicare beneficiary can choose from 43 different Medicare Advantage plans.¹

Sounds interesting, right? But what exactly is Medicare Advantage? And is this type of coverage right for you?

In this article, we’ll answer those questions and uncover the top 5 benefits of Medicare Advantage.

What is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is an alternative way to get your Medicare benefits.²

Instead of enrolling in Original Medicare, you can choose a Medicare Advantage plan from a private insurance company.

These plans cover everything Original Medicare does, like doctor visits and hospital stays. Many also include extra benefits for health and wellness services you may need.

You still have to follow certain rules, like using doctors in your plan’s network, but for many people, Medicare Advantage offers more all-in-one coverage options.

It’s a popular choice, because it combines several types of health coverage into one plan.

So what are the top 5 benefits of Medicare Advantage plans?

1. Lower costs for prescription medications

Medicare Advantage Part D is a benefit that helps cover the cost of prescription drugs, which is especially helpful if you take medications regularly.

And it can save you money.

• Out-of-pocket cap. Medicare Advantage Part D will save about 19 million seniors an estimated $400 per year when the out-of-pocket cost cap drops to $2,000 in 2025, whether their plan is with Cigna, Aetna, UnitedHealthcare® or another company that offers Medicare Advantage Part D.³
• Annual savings. Medicare Advantage Part D enrollees with the highest drug costs will save an estimated $2,500 per year.³
• Cost of insulin. Medicare Advantage Part D caps monthly insulin costs at $35 per month for an estimated 3.4 million people.³
• Lower drug prices. Beginning in 2026, Medicare Advantage Part D enrollees will pay 38 to 79% less for 10 commonly-prescribed medications.³

If you need prescription medications, choosing a Medicare Advantage plan with Part D might simplify your healthcare and save you money.

2. Additional coverage for health & wellness services

While Original Medicare covers the basics, Medicare Advantage includes coverage for additional health and wellness services.⁴

It’s packed with value-added benefits that can make your life easier and healthier.

If you don’t want all the benefits of Medicare Advantage, you can stick with Original Medicare and customize your coverage by:

• Adding Part D for prescription drugs
• Buying a separate supplemental plan for dental, vision or hearing
• Choosing a Medigap (Medicare Supplement Insurance) plan, which helps cover out-of-pocket costs like deductibles, copayments, and coinsurance.⁵

3. Cap on out-of-pocket expenses

When deciding between Original Medicare and Medicare Advantage, one thing to think about is how much you might spend out of pocket.

With Original Medicare, there is no limit on how much you could end up paying for things like copayments or coinsurance. This means your costs could keep adding up, especially if you need a lot of medical care.

On the other hand, Medicare Advantage plans do have a cap on out-of-pocket costs:

• That limit is $8,850 for in-network services and $13,300 for in-network and out-of-network services combined (not including prescriptions).⁷
• Beginning in 2025, out-of-pocket costs for prescription drug spending will be capped at $2,000.⁸

Once you reach these amounts, the plan covers 100% of your costs for the rest of the year. This can protect you from higher expenses if you need frequent medical care.

4. Simple network coverage

When deciding between Original Medicare and Medicare Advantage, one key difference is how they handle network coverage (which doctors and hospitals you can use).²

With Original Medicare, you have no restrictions on which doctors you can see.

• You can visit any doctor or specialist who accepts Medicare, and you don’t need referrals or to stick to certain networks.
• There are also no limits on where you can get care in the U.S., so it’s very flexible.

With Medicare Advantage, you usually must use doctors and hospitals within the plan’s network.

• This means you may need to choose from specific providers within the plan’s preferred network.
• Sometimes, you might also need approval before getting certain prescriptions or treatments.
• However, new Medicare Advantage rules are helping to expand networks and offer more services, so you may have more options now than in the past.⁹

5. Fixed copayments

When choosing between Original Medicare and Medicare Advantage, one important thing to think about is how you’d like to pay for your health services:

• Coinsurance is the percentage of costs of a covered health care service you pay after you’ve paid your deductible.¹⁰
• A copayment is a fixed amount you pay for a covered health care service after you’ve paid your deductible.¹¹

With Original Medicare, you pay 20% of the cost of most services.²

• This is called coinsurance.
• So, if a doctor’s visit costs $100, you would pay $20, and Medicare would pay the other $80. Your costs depend on how much the service costs.
• There is no yearly limit on the amount of coinsurance you might pay with Original Medicare.

With Medicare Advantage, you may pay a copayment.

• A copayment is a fixed amount you pay every time you go to the doctor or get a service.
• For example, you might pay a $20 copayment for a doctor’s visit through a Medicare Advantage plan, with Cigna, Aetna, UnitedHealthcare®, or another company that offers Medicare Advantage, no matter what the full cost of the visit might be.
• Medicare Advantage plans, which can be through health maintenance organizations (HMOs) or preferred provider organizations (PPOs), structure your costs differently. They can offer copayments—fixed amounts you pay every time you get health services.
• Medicare Advantage plans have a yearly limit you pay for in-network and out-of-network charges. Once you reach the maximum limit, you pay nothing for covered services for the rest of the year.

Looking for a Medicare Advantage plan?

We can help. Deciding between Original Medicare and Medicare Advantage can be tough, but now you know the key benefits of Medicare Advantage.

With extra coverage for things like prescriptions, plus a cap on out-of-pocket costs, it offers more all-in-one convenience.

So what are your options? Give us a call at (800) 827-9990 to speak with a licensed insurance agent or find a licensed insurance agent in your area, and we’ll help you find the right plan.