Medicare Advantage questions, answered simply
Straight answers about costs, doctors, drug coverage and when you can make changes. Costs and benefits vary by plan and county, so we'll confirm the details for you.
The basics
What is Medicare Advantage?
Medicare Advantage (Part C) is another way to get your Part A and Part B benefits. The plans are offered by private insurance companies approved by Medicare.
Most plans also include Part D drug coverage. Some add extra benefits, such as dental or vision. These vary by plan, and not all plans include them.
Is Medicare Advantage the same as a Medicare Supplement (Medigap)?
No. They work very differently. A Medicare Advantage plan covers your Part A and B care, usually through a network. A Supplement works alongside Original Medicare and helps pay what Medicare leaves behind.
You don't use them together. It's illegal for anyone to sell you a Medigap policy while you're in a Medicare Advantage plan, unless you're switching back to Original Medicare.
If you already have a Supplement and join an Advantage plan, the Supplement can't pay your Advantage plan's costs. Talk with us before you drop a Supplement, because getting one back later may mean health questions.
Do I need Part A and Part B to join?
Yes. You need both Part A and Part B, and you need to live in the plan's service area. You keep paying your Part B premium while you're in the plan.
Does Medicare Advantage include drug coverage?
Most plans do. In 2027, what you pay for covered Part D drugs is capped at $2,400 for the year (it was $2,100 in 2026). The most a plan can set as its drug deductible in 2027 is $700.
If you choose an Advantage plan without drug coverage, in most cases you can't add a separate Part D plan. We'll help you check this.
Costs
Will a $0 premium plan really cost nothing?
No. A $0 premium plan has no separate monthly plan premium, but you still pay your Part B premium. $0 premium plans aren't available everywhere.
You may also pay copays, coinsurance or deductibles when you get care. We'll walk through what you'd likely pay for the care you use.
Do I still pay my Part B premium?
Yes, with any Advantage plan. The 2026 standard Part B premium is $202.90 a month. For 2027, the Medicare Trustees project about $209.50 a month; Medicare usually announces the official amount in November.
Is there a limit on what I pay each year?
Yes. Every Medicare Advantage plan has a yearly out-of-pocket limit for covered Part A and Part B services. The amount varies by plan. Drug costs count toward the separate Part D cap instead.
Do plans include dental, vision and hearing?
Some do. Extra benefits like dental, vision, hearing, over-the-counter items and fitness vary by plan, and not all plans include them. We'll check what each plan in your area actually covers.
Does it cost anything to work with you?
No. There's no fee for our help. Insurance companies pay agents when someone enrolls. Plan prices are set by the insurance company, not by us.
Doctors and networks
Can I keep my current doctor?
It depends on the plan's network. Most Advantage plans use HMO or PPO networks. We check your doctors in each plan's directory with you before you enroll.
Networks can change, so it's worth checking again each year.
What's the difference between an HMO and a PPO?
HMO: you usually use the plan's network, except in emergencies. You may need a referral to see a specialist.
PPO: you can see doctors outside the network, usually at a higher cost. Rules vary by plan.
What if I travel or live somewhere else part of the year?
Emergency and urgent care are covered anywhere in the U.S. Routine care is usually tied to your plan's local network. If you spend part of the year in another state, tell us. It can change which kind of plan fits best.
Enrolling and making changes
When can I join or change plans?
- When you're new to Medicare: you can join when you first get Part A and Part B.
- Annual Enrollment Period: October 15 – December 7. Changes start January 1.
- Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in an Advantage plan, you can switch plans or go back to Original Medicare once.
- Special Enrollment Periods: certain events, like moving or losing coverage from work, can let you make a change at other times.
Do plans change every year?
Yes. Plans can change their premiums, benefits, drug lists and networks each year. Your plan sends a notice of changes each fall. It's worth reviewing your plan every Annual Enrollment Period, even if you're happy with it.
Can I switch from Advantage back to a Supplement?
You can return to Original Medicare during certain enrollment periods. Buying a Supplement at that point may mean answering health questions, and an insurer may say no.
Some people have special rights to buy a Supplement in certain situations. Ask us before you make a change so you know where you stand.
Do I have to sign anything before we talk?
Before we talk about specific plans, Medicare requires a short Scope of Appointment form. We'll send it to you. It only confirms which types of plans you want to discuss. It doesn't enroll you in anything.
About us
Are you part of Medicare or the government?
No. Sowder Insurance is a private, independent agency. We aren't connected with or endorsed by Medicare, CMS or any government agency.
Do you offer every plan in my area?
No. We work with several insurance companies, and what's available varies by state and county. For information on all your options, you can also contact Medicare.gov or 1-800-MEDICARE. Your state's free SHIP counseling program can also help.
Want help comparing plans?
We'll check your doctors, prescriptions and pharmacy against plans in your area. There's no cost for our help.