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)
Many plans also include:
- Dental
- Vision
- Hearing
- Gym memberships
- Over-the-counter benefits
These are often called “all-in-one” plans
how they work
Instead of using Original Medicare directly, you receive your care through the plan’s network.
That means:
- 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)
Every plan is different — even within the same county
important trade-offs
This is where most agents stay quiet — we don’t.
Provider Networks Matter
Not all doctors and hospitals accept every plan
Just because a doctor “accepts Medicare” does NOT mean they accept your specific plan
⚠️ Plans Can Change Every Year
Benefits, networks, and drug coverage can change annually
👉 This is why reviewing your plan each year is critical
⚠️ Prior Authorization
Some services require approval before being covered
⚠️ Referrals (for some plans)
HMO plans often require referrals to see specialists
Key Benefits
Lower Monthly Premiums
Extra Benefits
Built-In Prescription Coverage
Annual Out-of-Pocket Protection
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 careful
- 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
In New York and Long Island, provider networks can vary significantly between plans.
Some plans may include major hospital systems like:
- Northwell Health
- NYU Langone Health
- Catholic Health
- Mount Sinai Health System
cost structure
this is what people really care about
With Medicare Advantage, your costs typically include:
- Monthly premium (sometimes $0)
- Copays (doctor visits, specialists, ER)
- Coinsurance (for certain services)
Each plan also has a maximum out-of-pocket limit, which protects you financially.
👉 In 2026, this can be as high as $9,250 — but many plans are much lower.
why work with aja
Choosing a Medicare Advantage plan isn’t just about picking the lowest premium.
It’s about:
- Making sure your doctors are covered
- Checking your prescriptions
- Understanding the real costs
- Avoiding surprises later
That’s exactly what I help you do.