Understanding Medicare Advantage

What Is Medicare Advantage (Part C)?

Medicare Advantage is an alternative way to receive your Medicare benefits. Instead of getting coverage directly from the federal government (Original Medicare), you enroll in a plan offered by a private insurance company that has been approved by Medicare.

These plans are required to cover everything that Original Medicare (Part A and Part B) covers. Most Medicare Advantage plans also include additional benefits that Original Medicare does not offer, such as:

• Prescription drug coverage (Part D)
• Routine dental, vision, and hearing services
• Fitness and wellness programs
• Transportation to medical appointments
• Telehealth services
• Over-the-counter allowances

Note: Specific benefits vary by plan and location. Not all plans include all of the benefits listed above.

How Is Medicare Advantage Different From Original Medicare?

Feature	Original Medicare	Medicare Advantage
Coverage source	Federal government	Private insurance company (approved by Medicare)
Provider network	Any provider that accepts Medicare	Plan-specific network (HMO or PPO)
Prescription drugs	Separate Part D plan required	Usually included
Dental, vision, hearing	Generally not covered	Often included
Out-of-pocket maximum	No annual cap	Annual cap on what you pay
Supplemental insurance needed	Often yes (Medigap)	Generally no

HMO vs. PPO: What Is the Difference?

Most Medicare Advantage plans are structured as either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). Here is a general comparison:

Feature	HMO	PPO
Must use in-network providers?	Yes (except emergencies)	No, but lower costs in-network
Referral required for specialists?	Usually yes	Usually no
Monthly premiums	Often lower	May be higher
Flexibility	Less flexible	More flexible

Which type is right for you depends on how important provider flexibility is to you and whether your preferred doctors are in a particular plan's network.

When Can You Enroll?

There are specific times of year when you can enroll in or change a Medicare Advantage plan:

• Initial Enrollment Period (IEP): A seven-month window around your 65th birthday (three months before, your birthday month, and three months after).
• Annual Enrollment Period (AEP): October 15 through December 7 each year. This is when you can switch plans for the following year.
• Medicare Advantage Open Enrollment Period (OEP): January 1 through March 31. If you are already in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare during this window.
• Special Enrollment Periods (SEP): Certain life events — such as moving to a new area, losing employer coverage, or qualifying for Medicaid — may allow you to enroll or make changes outside of the standard enrollment periods.

What Should You Consider When Choosing a Plan?

Every person's situation is different. Here are the key factors to think about:

1. Are your doctors in-network? Check whether your primary care physician and any specialists you see regularly participate in the plan's provider network.
2. Are your prescriptions covered? Each plan has a formulary (a list of covered medications). Verify that your current medications are included and check what your copay would be.
3. What is your budget? Look at the full picture: monthly premium, deductibles, copays for doctor visits and prescriptions, and the annual out-of-pocket maximum.
4. Do you travel or split time between states? If you spend time in both Utah and Arizona (or travel frequently), a PPO plan may offer more flexibility for out-of-area care.
5. What extra benefits matter to you? Dental, vision, hearing, fitness programs, and transportation benefits vary widely between plans. Think about which ones you would actually use.

Medicare Advantage for Active Lifestyles

If you lead an active lifestyle — hiking, skiing, golfing, or simply staying on the move — there are a few things worth paying attention to when evaluating plans:

• Fitness benefits: Many Medicare Advantage plans include gym memberships or fitness programs at no additional cost. These programs can include access to fitness centers, group classes, and home fitness kits.
• Wide provider networks: If your activities take you across different parts of the state (or between Utah and Arizona), a plan with a broad network or PPO structure may serve you well.
• Urgent and emergency care while traveling: All Medicare Advantage plans cover emergency care anywhere in the U.S., but coverage for urgent care outside your plan's service area varies. This is especially relevant for snowbirds and frequent travelers.
• Preventive care and screenings: Staying active means staying on top of preventive health. All Medicare Advantage plans cover preventive services, but some offer additional wellness benefits.

Utah and Arizona are both states where an active retirement is common. Your Medicare Advantage plan should support that lifestyle, not limit it.

How a Local Agent Can Help

There are dozens of Medicare Advantage plans available in most Utah and Arizona counties. Comparing them on your own means navigating different networks, formularies, costs, and benefit structures. A local agent can:

• Help you understand which plans include your specific doctors and hospitals
• Check whether your prescriptions are covered and at what cost
• Compare plans side by side based on what matters to you
• Walk you through the enrollment process
• Provide ongoing support after you are enrolled

This guidance comes at no cost to you. Agent compensation is paid by the insurance carriers.