Medicare Advantage

Medicare plans are run by private insurance companies that have been approved by Medicare. These plans are often called “MA Plans”, “MAPD”, or “Part C”. By joining a Medicare Advantage Plan you are not getting rid of your Medicare. Your Part A (Hospital) and Part B (Medical) coverage goes through your Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans are required to cover all of the services that Original Medicare covers except hospice care and some care in qualifying clinical research studies. Original Medicare covers hospice and some costs for clinical research studies even if you have a Medicare Advantage Plan.

Why choose a Medicare Advantage Plan?

Many people choose Medicare plans because they typically have lower out-of-pocket costs. These plans also typically include extra benefits and services such as the following:

Low premiums (Many $0)
Gym membership or fitness program
Hearing Aids
Over-the-Counter benefit
Dental or Vision coverage

Most Medicare plans also include Prescription Drug Coverage (Part D) as well.

Types of Medicare Advantage plans are:

HMO (Health Maintenance Organization) – with the HMO you have a primary care physician that “facilitates” your healthcare all within a plans’ network of providers.
PPO (Preferred Provider Organization) – with the PPO you are able to choose any provider, but for the lowest cost you would use in-network providers
PFFS (Private-Fee-for-Service) – choose any provider that excepts the plans terms and conditions, typically at a higher premium

When can I enroll in a Medicare Plan?

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What is a Medicare Advantage Plan?

Medicare Advantage, also known as Medicare Part C, is an all-in-one alternative to Original Medicare. These plans are offered by private companies approved by Medicare and bundle Part A (Hospital Insurance), Part B (Medical Insurance), and usually Part D (Prescription Drug Coverage) into a single plan.

How do Medicare Advantage plans work with Original Medicare?

When you join a Medicare Advantage plan, you still have Medicare. However, you get your Medicare Part A and Part B coverage from the Medicare Advantage Plan, not Original Medicare. You must continue to pay your Part B premium to stay enrolled.

What extra benefits do Medicare Advantage plans offer?

Many Medicare Advantage plans offer coverage for services not covered by Original Medicare, such as dental care, vision exams, hearing aids, wellness programs like SilverSneakers, and even transportation to medical appointments.

Are there $0 premium Medicare Advantage plans available?

Yes, many areas offer Medicare Advantage plans with a $0 monthly premium. While you must still pay your monthly Medicare Part B premium, the private insurer does not charge an additional monthly fee for the Part C plan itself.

What is the difference between HMO and PPO Medicare Advantage plans?

HMO (Health Maintenance Organization) plans usually require you to see doctors within a specific network and get referrals for specialists. PPO (Preferred Provider Organization) plans offer more flexibility, allowing you to see out-of-network providers, typically at a higher out-of-pocket cost, without a referral.

Can I have both a Medicare Advantage plan and a Medigap policy?

No. It is illegal for anyone to sell you a Medicare Supplement (Medigap) insurance policy if you are enrolled in a Medicare Advantage plan. Medigap policies only work with Original Medicare.