Medicare Advantage (Part C)

Medicare Advantage, also known as Part C, is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare (Parts A and B) covers, but they do so through their own network of doctors and hospitals — often with additional benefits like dental, vision, hearing, and prescription drug coverage built in. The federal government pays the private insurer a fixed amount to manage your care. You still pay your Part B premium ($202.90/month in 2026), and the plan may charge its own additional premium on top of that — though many plans charge $0 extra.

In 2026, the average monthly Medicare Advantage premium is $14.00 — down from $16.40 in 2025. Two-thirds of all Medicare Advantage plans with drug coverage charge $0 in additional premium beyond the standard Part B premium. You will still pay your Part B premium of $202.90/month. Beyond premiums, Advantage plans use copays and coinsurance for services, and have an annual out-of-pocket maximum of $9,250 for in-network services in 2026 — once you hit that cap, the plan pays 100% for covered services for the rest of the year. Brad can compare plans side by side to find the best value for your needs.

There are several types of Medicare Advantage plans:

• HMO (Health Maintenance Organization) — requires you to use in-network providers and get referrals for specialists. Lowest premiums.
• PPO (Preferred Provider Organization) — allows out-of-network care at a higher cost; no referrals needed.
• PFFS (Private Fee-for-Service) — sets its own payment terms; any provider who accepts the plan's terms may treat you.
• SNP (Special Needs Plan) — designed for people with specific chronic conditions, dual eligibility (Medicare + Medicaid), or institutional care needs.

Brad can walk you through which plan type makes the most sense for your health needs and preferred providers.

Most do — in 2026, 89% of Medicare Advantage plans include Part D prescription drug coverage built in (called MA-PD plans). This means you typically do not need to purchase a separate Part D plan if you enroll in one of these. Each plan has its own formulary (drug list) and tier structure, so it's important to confirm your specific medications are covered before enrolling. Brad reviews your current prescriptions against available plans to make sure you get the best drug coverage at the lowest cost.

Medicare Advantage plans can offer benefits far beyond what Original Medicare covers. In 2026, nearly all plans offer: dental, vision, and hearing coverage; fitness memberships (93% of plans); and many offer over-the-counter item allowances (66% of plans). Some plans also offer meal delivery, transportation to medical appointments, home safety modifications, and caregiver support. Additionally, in 2026, all plans are required to match or improve upon Original Medicare's cost-sharing for mental health and substance use disorder services. Benefits vary by plan and location — Brad can help you find a plan with the extra benefits that matter most to you.

Yes — this is one of the most valuable and overlooked features of some Medicare Advantage plans. In 2026, nearly one-third of individual Medicare Advantage plans offer a Part B premium reduction as a supplemental benefit. Among those plans, more than a third offer reductions of over $100/month. This means some enrollees effectively pay less than $202.90/month for their Part B coverage. Plan availability varies by ZIP code, so not every plan is available in every area. Brad can check which premium-reducing plans are available to you in Wisconsin.

Yes, most Medicare Advantage plans use provider networks. With an HMO, you must generally use in-network doctors and get referrals for specialists — going out of network typically means paying full cost. With a PPO, you can see out-of-network providers but pay more. All Medicare Advantage plans are required to cover emergency and urgent care nationwide regardless of network. Starting in 2026, the Medicare Plan Finder now shows provider network information directly, making it easier to confirm your doctors are covered before you enroll. Brad can verify your preferred providers are in-network before you sign up.

There is no one-size-fits-all answer — it depends on your health, budget, and priorities:

• Medicare Advantage — typically lower or $0 premiums, extra benefits (dental, vision, hearing), annual out-of-pocket cap, but limited to a provider network and may require referrals.
• Original Medicare + Supplement — higher monthly premiums, but access to virtually any doctor in the U.S. who accepts Medicare, no referrals, and predictable out-of-pocket costs with no network restrictions.

Brad specializes in comparing both options side by side for Wisconsin residents. Call (920) 251-4969 for a free no-obligation review.

There are several enrollment windows:

• Initial Enrollment Period (IEP) — the 7-month window around your 65th birthday when you first become eligible for Medicare.
• Annual Enrollment Period (AEP) — October 15 through December 7 each year; changes take effect January 1.
• Medicare Advantage Open Enrollment Period (OEP) — January 1 through March 31; allows you to switch Advantage plans or return to Original Medicare once.
• Special Enrollment Period (SEP) — triggered by qualifying life events such as moving, losing other coverage, or changes in plan availability.

No — it is illegal to be enrolled in both simultaneously. Medicare Supplement (Medigap) plans are designed to work alongside Original Medicare only. If you enroll in a Medicare Advantage plan, your Medigap coverage cannot pay for any costs, making it useless and a waste of premium dollars. An agent is prohibited by law from knowingly enrolling you in both. If you want the flexibility of a Supplement, you must be on Original Medicare. Brad will always make sure your coverage is structured correctly and legally.