Medicare Part C
Medicare Advantage
Medicare Advantage (MA) is an alternative way to get your Medicare benefits through a private insurance company. These plans must cover everything Original Medicare covers — and most go further with extra benefits and built-in drug coverage.
How Medicare Advantage Works
When you enroll in a Medicare Advantage plan, you're still on Medicare — the government pays the private insurer to provide your coverage. You must continue paying your Part B premium, and you stay enrolled in Parts A and B. But instead of Medicare paying your claims directly, your MA plan does.
Everything in Parts A & B
Required by law
Part D Drug Coverage
Included in most MA plans
Extra Benefits
Dental, vision, hearing & more
Extra Benefits Original Medicare Doesn't Cover
These vary by plan and county — not every plan offers all of these, but many do:
Types of Medicare Advantage Plans
HMO – Health Maintenance Organization
You choose a primary care doctor who coordinates your care. You generally need referrals to see specialists, and you must stay in-network for non-emergency care. Most HMOs have lower premiums and out-of-pocket costs.
PPO – Preferred Provider Organization
More flexibility — you can see any doctor who accepts Medicare, in or out of network, without a referral. Out-of-network care costs more but is still covered. Typically higher premiums than HMOs.
PFFS – Private Fee-for-Service
The plan sets its own payment rates. You can see any provider who agrees to the plan's terms. Common in rural Wisconsin counties where HMO networks are limited.
Medicare Advantage vs. Original Medicare
| Medicare Advantage | Original Medicare + Supplement | |
|---|---|---|
| Monthly cost | Often $0–$50 plan premium (+ Part B) | Part B premium + Medigap premium |
| Out-of-pocket max | Yes — capped by law each year | No cap with Original Medicare alone |
| Network | Usually in-network only (HMO) or preferred (PPO) | Any provider that accepts Medicare — nationwide |
| Drug coverage | Usually included (MAPD) | Add separate Part D plan |
| Extra benefits | Often includes dental, vision, hearing | Not included |
| Best for | People who want low premiums and extra perks | People who want maximum flexibility and predictability |
The "right" choice depends on your health needs, budget, doctors, and the plans available in your Wisconsin county. This is exactly where an independent agent can help.
When Can You Join or Switch?
Initial Coverage Election Period — Your 7-month IEP around your 65th birthday
Your first chance to join a Medicare Advantage plan.
Annual Enrollment Period (AEP) — October 15 – December 7
Switch plans, join a plan, or drop MA and return to Original Medicare. Changes take effect January 1.
Medicare Advantage Open Enrollment — January 1 – March 31
If you're already in an MA plan, you can switch to a different MA plan or return to Original Medicare.
Special Enrollment Periods — Varies by qualifying event
Moving, losing employer coverage, or qualifying for Medicaid may trigger an SEP to change plans outside normal windows.
Find the Right Medicare Advantage Plan in Your County
Plan availability and benefits vary significantly by Wisconsin county. We compare options across all carriers at no cost to you.
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