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Medicare Advantage Plans 101

Medicare Advantage Plans 101

Today, we’re diving into the world of Medicare Advantage Plans, or as I like to call them, the “Part C of the party.”

Medicare Advantage Plans are an alternative to Original Medicare. They’re offered by private insurance companies approved by Medicare.

Making Sense of Medicare Advantage Plans

Medicare Advantage Plans provide all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. They often include additional benefits, like vision, dental, and hearing care. Premiums, co-pays, and coverage can be as varied as your grandma’s secret recipes. So, it’s crucial to evaluate these plans based on your own health needs.

Let’s talk differences between Original Medicare and these fancy Advantage Plans. It’s sort of like choosing between your grandma’s apple pie and a store-bought one – both good, but one might have a few extra goodies!

  • Original Medicare – That’s like the classic model straight from the federal government, and includes Part A and Part B. It offers coverage for hospital stays and outpatient care but doesn’t cover most prescriptions. It’s like that tried-and-true pickup truck – reliable but might need a few extra add-ons.
  • Medicare Advantage Plans, the private sector darlings, cover both your Part A for hospital stays and Part B for medical services. You get all the coverage of Original Medicare like a warm blanket on a chilly night – plus a bunch of extra goodies like prescription drug benefits and often additional coverage like dental, vision, dental, and hearing. It’s like adding extra toppings to your pizza but for your health!

Here’s a breakdown of features:

Original Medicare

  • Provider Network – Any doctor/hospital that accepts Medicare
  • Prescription Drugs – Not covered – you need a separate Part D plan.
  • Out-of-Pocket Costs – No maximum limit.
  • Need for Referrals – No need – you’re the captain of your healthcare ship.

Medicare Advantage Plan

  • Provider Network – Typically, a set network of providers
  • Prescription Drugs – Most plans include Part D coverage.
  • Out-of-Pocket Costs – Annual out-of-pocket maximum – like putting a ceiling on your expenses.
  • Need for Referrals – Often required for specialists.

Medicare Advantage Plan Pros and Cons


  • Additional Coverage: Often includes dental, vision, hearing, and prescription drugs.
  • All-in-One Convenience: Bundles various healthcare services into one plan.


  • Provider Restrictions: You may need to see in-network healthcare providers. Plan availability and options vary significantly depending on location.
  • Pre-authorization: Sometimes required for services to determine if they are medically necessary.

Medicare Advantage Plans | Questions and Answers

• Q: Are there different types of Medicare Advantage Plans?
A: Yes, there are several types, including HMOs, PPOs, Special Needs Plans [SNPs], HMO-POS Plans, and others. It’s like a buffet of options – pick what suits your taste.

• Q: Can I switch from Original Medicare to a Medicare Advantage Plan anytime?
A: No, there are specific enrollment periods, such as when you first become eligible for Medicare and during the Annual Election Period from OCTOBER 15th to DECEMBER 7th.

• Q: Does a Medicare Advantage Plan affect my eligibility for Medicare Supplement Insurance (Medigap)?
A: Having an Advantage Plan means you can’t use Medigap coverage. It’s like trying to wear two hats at once – doesn’t quite work.

Got more questions about Medicare Advantage plans ? Reach out to your trusted, independent Medicare broker. We’re here to help you make informed decisions about your Medicare coverage.

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