WFI Healthcare AgencyMedicare Advantage · Part C
Medicare Advantage Plans
Medicare Advantage is a private-plan alternative to Original Medicare that bundles your hospital (Part A), medical (Part B), and usually prescription (Part D) coverage into a single plan — often adding dental, vision, and hearing benefits Original Medicare doesn’t cover. More than 34 million people are enrolled. Here’s how it works, what it costs in 2027, and whether it fits.
Do you qualify?
Advantage eligibility is straightforward — it comes down to three things.
- 1
Enrolled in Part A & B
You must already have Original Medicare (both Part A and Part B) before you can join an Advantage plan.
- 2
Live in the service area
Advantage plans are regional. You must live in the plan’s service area — availability and pricing vary by county.
- 3
In an enrollment window
You can join when newly eligible, during the Fall Annual Enrollment Period, or via a Special Enrollment Period.
What it costs in 2027
You keep paying your Part B premium either way. Beyond that, Advantage costs are plan-specific — but a few numbers are set nationally.
~$209.50/mo
Part B premium (2027, projected)
You keep paying this to Medicare whether or not you choose Advantage.
$0 - low
Plan premium
Many Advantage plans have a $0 monthly premium; costs come through copays instead.
$2,400
Part D drug cap (2027)
If the plan includes drug coverage, your covered-drug spending is capped at $2,400 for the year.
Annual max
Out-of-pocket limit
Every plan caps your yearly in-network costs — a safety net Original Medicare doesn’t have. Medicare sets the ceiling at $9,850 for in-network in 2027; many plans set theirs lower.
Advantage vs. Original Medicare
The real trade-off is flexibility versus bundling. Neither is "better" — it depends on how you use care.
| Category | Medicare Advantage | Original Medicare |
|---|---|---|
| Doctors | In-network (HMO/PPO); referrals often needed on HMOs | Any provider nationwide who accepts Medicare |
| Drug coverage | Usually built in | Requires a separate Part D plan |
| Extra benefits | Often dental, vision, hearing, fitness | Not included |
| Out-of-pocket cap | Yes — annual maximum | No cap (many add Medigap for protection) |
| Prior authorization | Common for some services | Very rare |
When you can enroll
Three main windows apply to Advantage.
- IEP
Initial Enrollment
Your 7-month window around turning 65 — the first time you can pick an Advantage plan.
- AEP · Oct 15–Dec 7
Annual Enrollment
Join, switch, or drop an Advantage plan each fall; changes take effect January 1.
- MA-OEP · Jan 1–Mar 31
Advantage Open Enrollment
Already in an Advantage plan? Make one switch — to another plan or back to Original Medicare.
- SEP
Special Enrollment
Moving, losing coverage, or gaining/losing Medicaid can open a window outside the usual dates.