Plan guide
Medicare Advantage
One card, one plan, an annual out-of-pocket limit and often dental and vision. The trade-off is a provider network.
Overview
Medicare Advantage plans, also called Part C, are offered by private insurance companies approved by Medicare. They must cover everything Original Medicare covers, and most in Marion and Hamilton counties also include Part D drug coverage, routine dental, vision exams, hearing aid allowances and a fitness membership.
Instead of open-ended 20 percent coinsurance, you pay set copays for visits and services, and every plan has a yearly in-network out-of-pocket maximum. Many plans in our area carry a $0 monthly premium beyond your Part B premium.
The main trade-off is the network. HMO plans generally require you to use in-network doctors and get referrals, while PPO plans let you go out of network at a higher cost. Before we recommend any Advantage plan, we check every one of your doctors, specialists and hospitals against its current directory.
What's included
Hospital and medical coverage
Everything Parts A and B cover, with plan-specific copays instead of open coinsurance.
Prescription drugs
Most plans (MAPD) include Part D, with a formulary, preferred pharmacies and drug tiers.
Routine dental, vision and hearing
Cleanings, exams, eyewear allowances and hearing aid benefits vary by plan.
Out-of-pocket maximum
A yearly cap on in-network costs for Part A and B services.
Wellness extras
Fitness memberships, over-the-counter allowances and nurse lines on many plans.
Care coordination
Some HMO plans assign care managers who help with referrals and chronic conditions.
Check the network before you enroll
A Medicare Advantage plan is only as good as the providers who will actually bill it. Six steps our advisors run for every client, in this order.
Write down the plan's full name and its ID
Not the carrier, the plan. Each one carries a contract and benefit package number that looks like H1234-001. Two plans from the same carrier in the same county can hold different networks.
Search the directory for next year, not this one
Use the directory for the plan year you will actually be in. Note the address beside each name, because a doctor can be in network at one location and out at another.
Call the billing office, not the front desk
Ask the billing office in these words: are you contracted with this plan, under this contract number, for the 2026 plan year? Front desk staff often answer for the carrier instead of the plan.
Check the hospital, lab and imaging separately
A contracted physician can admit to a hospital that is not contracted and send blood work to a lab that is not either. Each one bills you on its own network status.
Ask what needs a referral or prior authorization
In network is not the same as reachable. HMO plans usually need a referral, and imaging, surgery, infusions and skilled nursing often need prior authorization even in network.
Call the plan last and get a reference number
Repeat what the office told you, then write down the representative's name, the date and the call reference. That note is what you use if a claim is denied later.
Networks change during the year
A provider can leave a Medicare Advantage network mid-year. You are usually offered continuity of care for a course of treatment already under way, and if CMS calls the change significant it can open a Special Enrollment Period.
Directories are known to be wrong
CMS audits Medicare Advantage directories and keeps finding listed providers who do not accept the plan, sit at the wrong address, or retired. A directory entry is a lead, not a guarantee.
Original Medicare has no network to check
With Parts A and B plus a Supplement, any provider in the country who accepts Medicare assignment takes your coverage. Nothing needs verifying each year. That is the trade you make on premium.
Costs to plan for
Sample figures- Monthly plan premium
- $0 to $95
- Primary care copay
- $0 to $10
- Specialist copay
- $25 to $50
- In-network out-of-pocket max
- Up to $9,250
Typical range in Central Indiana, plus your Part B premium (sample)
In-network, varies by plan (sample)
In-network, may require a referral (sample)
Federal limit for 2026, many plans set lower (sample)
Figures are illustrations for Central Indiana. Your actual costs depend on the plan, your ZIP code, age and income. Confirm current amounts at Medicare.gov.
How we help with Medicare Advantage
- 1
List your doctors and drugs
We gather your providers, prescriptions, pharmacies and any planned procedures.
- 2
Screen local plans
We filter HMO and PPO plans in your ZIP code by network, drug costs and star rating.
- 3
Walk through the trade-offs
You see total estimated yearly cost, not just the premium, for your top two or three options.
- 4
Enroll and follow up
We submit your application, confirm your ID card arrives, and check in after your first visit.
Is it a fit?
Often a good fit when
- Your doctors and hospital are in the plan's network
- You want dental, vision and hearing in one plan
- You prefer a yearly cap on costs and a low premium
Watch out for
- Networks can change each year
- Prior authorization is common for some services
- Switching back to a Supplement later may require health questions
Questions about Medicare Advantage
You still pay your Part B premium, and you pay copays when you use care. A $0 premium plan can be a good value, but we always compare the total yearly cost based on how you actually use care.
An HMO usually requires in-network providers and referrals to specialists. A PPO lets you see out-of-network providers at a higher cost and generally does not require referrals. PPOs often have a higher premium.
Yes, during the Annual Enrollment Period from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31. Moving to a Supplement plan may require medical underwriting in Indiana.
Emergency and urgent care are covered nationwide. Routine care outside the service area is limited on HMO plans. PPO plans and some national networks offer more flexibility for snowbirds.
Medicare rates plans from 1 to 5 stars on quality and member experience. A 5-star plan also lets you switch into it once during the year with a special enrollment period.
Related coverage
Part D drug plansStand-alone prescription drug coverage to pair with Original Medicare and a Supplement.Read the guide 
Dental, vision and hearingCoverage for the routine care Original Medicare generally does not pay for.Read the guide 
Special Needs PlansAdvantage plans built for people with Medicaid, chronic conditions or long-term care needs.Read the guide
Questions about Medicare Advantage?
A licensed Beacon advisor will compare plans against your doctors, prescriptions and budget. No cost, no obligation.
Licensed in Indiana. TTY 711. Mon - Fri 8:00 am - 6:00 pm