What Is Medicare Advantage, Exactly?
Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. They must cover everything Original Medicare covers — but they often add benefits like dental, vision, hearing, and fitness programs.
Unlike Original Medicare, Advantage plans typically have networks of doctors and hospitals. Staying in-network usually costs less. Most plans also include Part D prescription drug coverage.
- • Hospital and medical coverage (Parts A & B)
- • Prescription drug coverage (most plans)
- • Dental, vision, and hearing (many plans)
- • Fitness benefits like SilverSneakers
- • $0 monthly premium options available
| Aspect | Original Medicare | Medicare Advantage |
|---|---|---|
| Premium | Usually $0 Part B premium | Often $0 additional |
| Networks | Any Medicare doctor | Network required |
| Drug coverage | Need separate Part D | Usually included |
| Extra benefits | Not included | Often included |
Three Types of Medicare Advantage
HMO Plans
Use a defined network of doctors. Primary care physician required. Usually lowest premiums and copays. Best for: People with established local doctors who want lower out-of-pocket costs.
PPO Plans
More flexibility to see out-of-network doctors at a higher cost. No referral required for specialists. Best for: People who travel frequently or want maximum doctor choice.
Special Needs Plans (SNPs)
Designed for people with specific chronic conditions, dual Medicare/Medicaid eligibility, or institutional care needs. Best for: People with complex health needs or those on both Medicare and Medicaid.
Ohio Medicare Advantage — What You Need to Know
Ohio has a competitive Medicare Advantage landscape. One critical consideration for Ohio clients: not every plan covers access to Ohio State University’s James Cancer Center or affiliated specialists. This is a question our team specifically evaluates for every client.
- • Plan networks vary significantly between carriers in Ohio
- • 2026 plan offerings have changed — annual review is critical
- • Some plans include extra benefits worth $200+/month
Questions About Medicare Advantage
Is Medicare Advantage the same as Medicare?
No. Medicare Advantage is a separate way to get your Medicare benefits through a private insurance company. It must cover everything Original Medicare covers, but often includes additional benefits.
What’s the difference between HMO and PPO plans?
HMO plans require you to use in-network doctors and get referrals for specialists. PPO plans allow out-of-network care at a higher cost and don’t require referrals.
Can I keep my current doctors with Medicare Advantage?
It depends on the plan’s network. We check your specific doctors against every available plan to ensure you keep the providers you trust.
Does Medicare Advantage cover prescriptions?
Most Medicare Advantage plans include Part D prescription drug coverage. We compare your medication list against each plan’s formulary to find the best fit.
What extra benefits do Ohio plans offer?
Many Ohio Medicare Advantage plans include dental, vision, hearing, fitness programs like SilverSneakers, and even over-the-counter allowances worth $200 or more per month.
When can I switch Medicare Advantage plans?
The Annual Enrollment Period runs October 15 through December 7 each year. There’s also an Open Enrollment Period from January 1 to March 31 for current Advantage members.
How does Medicare Advantage interact with OPERS or STRS retirement benefits?
This is a common question for Ohio retirees. Our team understands how OPERS and STRS benefits coordinate with Medicare and can help you make the best decision for your situation.
Not Sure If Medicare Advantage Is Right for You?
We compare every option against your specific situation — no charge. Get Your Free Plan Comparison