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What is Medicare Advantage?

Also known as Medicare Part C, or Medicare Private Health Plan (MPHP), Medicare Advantage is offered by private insurance companies that contract or partner with Medicare to provide an alternative to Medicare Part A (hospital insurance) and Part B (medical insurance).

While traditional Medicare has four specific parts; A, B, C and D, where each part covers hospital care, doctor and medical procedures and equipment and prescription drugs, they do not cover deductibles, co-pays and other medical services that can be quite costly.

However, there are two options through Medicare Part C; Medicare Advantage and Medicare Supplemental insurance (Medigap Plans) that does offer extra protection against additional health related costs.

Medigap is standardized by Medicare and the costs can vary just as with any insurance coverage. Medigap choices are from ten Plans that range from A-N, with F being the most expensive due to covering more beneficiary services with very few out-of-pocket expenses. But keep in mind, at the end of 2019, this plan will no longer be available to new enrollees.  These policies cover beneficiary services as long as the facility accepts Medicare.

Medicare Advantage can provide you a “one-stop shop” for all your health and prescription drug coverage needs. We can help you find the plan that best suit your life.
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Benefits of Medicare Advantage Plans

Often Medicare Advantage plans offer additional benefits than Original Medicare:

Medicare Advantage can often provide more covered services with lower out-of-pocket expenses than Medigap along with traditional Medicare. Typically, once you have met the maximum for the year, the rest of the year you may not have a cost for covered medical services. With Medicare Advantage Plans, there is not a maximum out-of-pocket expenses cap.

A Medicare Advantage plan through a private insurance company covers everything that Parts A, B and D cover with a small co-pay. The costs will vary for premiums and plans because Medicare Advantage is similar to private health insurance.

Vision / Hearing

Plans often cover routine eye exams, glasses, frames, lenses, and contacts. Additional discounts on vision care may apply when you use specific providers.

Original Medicare does not cover hearing aids or fitting exams for hearing aids. With Medicare Advantage Part C plans, there may be extra benefits available.

Special Needs Plans (SNPs)

Medicare Advantage offers three types of Special Needs Plans that are benefit centric to the unique needs of Medicare beneficiaries who meet specific eligibility criteria.

  • Chronic-Condition Special Needs Plans (C-SNP)
  • Institutional Special Needs Plans (I-SNP)
  • Dual-Eligible Special Needs Plans (D-SNP)

Routine Dental Care

Unlike original Medicare that only covers emergency procedures, some Medicare Advantage plans offer full dental coverage including cleaning, fillings, tooth extractions, or dentures.
Generally, Medicare Advantage dental coverage is the only way to get dental services covered under Medicare.

Prescription Drug Coverage /
Medication Therapy Management

Medicare Advantage Prescription Drug plan (MA-PD) is a Part C plan that includes prescription drug coverage offered by private companies that provide Part A, B, and D benefits contracted with Medicare.

Health and Wellness Programs

This benefit helps you focus on physical, mental, and emotional wellness to help you develop healthy life habits to improve the quality of life and increase independent living.
These programs offer multiple managed care networks of health care providers – coordinating and providing your health care more efficiently.

Cost Saving Premiums

You are responsible for Medicare Part B premiums, however, when you enroll in a Medicare Advantage plan, some premiums as low as $0 with a small copay instead of a coinsurance percentage. This makes cost-sharing less than Original Medicare.

We make Medicare Advantage simple to understand. We de-mystify the mystery of Medicare Advantage.
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Who can join a Medicare Advantage Supplement Insurance Plan?

You can! If:

  1. You have Medicare Part A and B
  2. You live in the plan’s service area
  3. Providing you do not have End-Stage Renal Disease (ESRD). However, you can enroll in a Special Needs Plan that accepts people with ESRD or in other special circumstances.
Types of Medicare Advantage Coverage Plans

Medicare Health Maintenance Organizations (HMOs) are private plans that the federal government pays to administer Medicare benefits. HMOs provide you with the same benefits, rights, and protections as Original Medicare. HMOs may have different costs, rules, restrictions, and offer additional benefits, such as vision and hearing care.

Medicare Preferred Provider Organizations (PPOs) are private companies that the federal government pays to administer Medicare benefits. Just as HMOs, PPOs provide you with the same benefits, rights, and protections as Original Medicare. HMOs may have different costs, rules, restrictions, and offer additional benefits, such as vision and hearing care.

Medicare Private Fee-for-Service (PFFS) plans are private companies that the federal government pays to administer Medicare benefits. Just as HMOs and PPOs, PFFSs provide you with the same benefits, rights, and protections as Original Medicare. Private Fee-for-Services may have different costs, rules, restrictions, and offer additional benefits, such as vision and hearing care.

Medicare Special Needs Plans (SNPs) are private companies that the federal government pays to administer Medicare benefits. Medicare Special Needs Plans offer the same benefits, rights, and protections as Original Medicare. Medicare Special Needs Plans may have different costs, rules, restrictions, and offer additional benefits, such as vision and hearing care.

Medicare Medical Savings Account (MSA) plans are private companies that the federal government pays to administer Medicare benefits. Medicare Medical Savings Account Plans offer the same benefits, rights, and protections as Original Medicare. MSA Plans may have different costs, rules, restrictions, and offer additional benefits, such as vision and hearing care. However, unlike other Medicare Advantage Plans, Medical Savings Account plans may include a high deductible health plan (HDHP) and a bank account to help pay your medical costs.

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When is Medicare Advantage Enrollment?

Medicare Advantage plans offer open enrollment at certain times of the year only if you are currently enrolled in Medicare Part A and B.
You can typically enroll in Medicare Advantage during:

This period is a seven-month span that includes the three months before, the month of, and the three months after the month you first become eligible for Medicare. Typically, the 65th birthday month or 25 months after you have collected disability benefits.

Special enrollment periods outside regular enrollment in Part B. This 8-month period lets you delay enrollment without penalty if you were previously covered by insurance through employment when you first became eligible for Medicare. Once you have enrolled in Part A and B coverage, you are then qualified to enroll in a Medicare Advantage Plan.

This period would run from January through March each year if you did not sign up for Medicare when you originally became eligible. Coverage starts July 1. Medicare Advantage sign up is from April through June, after you’ve signed up for Parts A and B during the General Enrollment Period.

During this open enrollment period, you are allowed to change your Medicare coverage from October 15 through December 7 each year to pick a new Medicare Advantage Plan, or switch between Original Medicare and Medicare Advantage or change your Part D coverage.

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Compare Medicare Supplement Insurance Plans Across Multiple Companies

Before deciding on a Medicare Supplement Insurance plan, shop around. Call us to help you compare policies to find a plan that is right for you:

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