Medicare Advantage Plans
What You Need to Know Before You Enroll
Medicare Advantage plans can be a great option — but they’re not one-size-fits-all. You’ve probably seen the commercials:
“$0 premiums, extra benefits, all-in-one coverage…”
And while some of that is true — there’s more to the story. My job is to help you understand both the advantages and the trade-offs, so you can make a confident decision based on your situation — not a sales pitch.
What Is Medicare Advantage
Medicare Advantage plans are offered by private insurance companies approved by Centers for Medicare & Medicaid Services.
They replace Original Medicare and typically include:
- Hospital coverage (Part A)
- Medical coverage (Part B)
- Prescription drug coverage (Part D — in most plans)
- Dental
- Vision
- Hearing
- Gym memberships
- Over-the-counter benefits
How They Work
- You may need to use specific doctors and hospitals
- Some services may require referrals or prior authorization
- Costs are typically pay-as-you-go (copays, coinsurance)
Key Benefits
Lower Monthly Premiums
Many plans offer $0 premiums (you still pay your Part B premium)
Extra Benefits
Coverage for things Original Medicare doesn’t include
Built-In Prescription Coverage
No need to enroll in a separate drug plan (in most cases)
Annual Out-of-Pocket Protection
Plans include a maximum out-of-pocket limit — a key financial safety net
Important Trade-Offs
Plans Can Change Every Year
- This is why reviewing your plan each year is critical
Prior Authorization
Referrals (for some plans)
Who Medicare Advantage Is Best For
- You’re comfortable using a provider network
- You want lower monthly premiums
- You like bundled coverage with extra benefits
- Your doctors are in-network
Who Should Be Careeful
- You want complete freedom to see any doctor nationwide
- You travel frequently or live in multiple states
- You prefer predictable costs over pay-as-you-go expenses
Local Insight
- Northwell Health
- NYU Langone Health
- Catholic Health
- Mount Sinai Health System
Cost Structure
(This Is What People Really Care About)
- Monthly premium (sometimes $0)
- Copays (doctor visits, specialists, ER)
- Coinsurance (for certain services)
With Medicare Advantage, your costs typically include:
- In 2026, this can be as high as $9,250 — but many plans are much lower.
Why Work With AJA
- Making sure your doctors are covered
- Checking your prescriptions
- Understanding the real costs
- Avoiding surprises later
Medicare Advantage Questions
This is one of the most important questions — and the answer is: it depends on the plan.
Every Medicare Advantage plan has its own network. Even if your doctor “accepts Medicare,” they may not accept that specific plan.
👉 I always check your doctors before you enroll — not after.
$0 premium plans are real, but you still pay your Medicare Part B premium. These plans work on a pay-as-you-go model, meaning you’ll have copays and coinsurance when you use services.
👉 They can be a great value — if the plan fits your needs.
This happens more often than people expect.
Plans can change their networks, benefits, and drug coverage each year.
👉 The good news: you have the opportunity to review and change your plan annually.
👉 The key: actually reviewing it — most people don’t.
Sometimes.
HMO plans typically require referrals. PPO plans usually don’t, but they may cost more if you go out-of-network.
👉 This is something we’ll factor into your decision upfront.
Not risky — just different.
Medicare Advantage trades lower premiums for network restrictions and variable costs.
Medigap trades higher premiums for flexibility and predictability.
👉 The right choice depends on your priorities — not what someone on TV says.