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What is Medicare Advantage?

Medicare Advantage plans are Medicare plans operated by private insurance companies which offer benefits that meet or exceed those found in Original Medicare. 

Medicare Advantage plans have a network of providers, which consist of doctors, pharmacies, hospitals and other healthcare services that are approved by the private insurance companies. The plan designs include HMOs, PPOs, POS, PFFS and MSAs.

Why Was Medicare Advantage Created?

After 40 years of existence, Medicare introduced an alternative to Original Medicare. With the rising costs associated with operating Original Medicare, programs were needed that would provide improved outcomes with lower costs.

Therefore, Congress passed the Medicare Modernization Act of 2003 which created Medicare Advantage plans.  The act was initially designed to create universal prescription drug entitlement;  however, it also replaced Medicare Choice Plus (Part C) with Medicare Advantage as an alternative to Original Medicare and Medigap.

The Pros and Cons of Choosing a
Medicare Advantage Plan

By selecting a Medicare Advantage plan, you can receive additional benefits not offered with  Original Medicare. However, there are some restrictions that are worth mentioning as well.   

Please carefully research all your options including Medicare Advantage before deciding on the benefit plans best suited for your situation.

The Advantages of Choosing A Medicare Advantage Plan

✓ coverage for routine hearing, vision and dental coverage for hearing aids and complimentary or discounted gym memberships.

✓ a fixed out of pocket maximum, lower premiums than Medigap plans.

✓ networks of credentialed providers.

✓ the freedom of choice every year to switch your plan during the Annual Election Period.

The Disadvantages of Choosing A Medicare Advantage Plan

✓ lower number of medical providers.

✓ the need for prior authorization for certain procedures.

✓ it sometimes isn’t compatible with other forms of retiree coverage.

Medicare Advantage Costs

Medicare Advantage plans operate with deductibles, coinsurance and copayments, where supplement programs will have a zero or low deductible for medical care. For budget conscious consumers, Medicare Advantage can save a consumer money on monthly premiums by combining medical and prescription coverage. 

To join a Medicare Advantage plan, you must have Medicare Parts A and B. You are still responsible to pay for your Part B premiums, plus any additional premium that the plan may charge.  You also must live in your plan’s service area.

What Does Medicare Advantage Cover?

Medicare Advantage provides the same benefits found in Original Medicare, with the exception of Hospice, which is still covered under Part A.

Medicare Advantage also offers benefits for dental, vision and hearing, as well as gym memberships, transportation and a 24-hour nurse line.

With lower premiums than Medigap, Medicare Advantage can provide a great value to those who want more benefits for their insurance dollars.

When Can You Enroll in Medicare Advantage?

There are three opportunities when you can enroll into Medicare Advantage.

You can enroll into a Medicare Advantage Plan during your Initial Coverage Election Period (ICEP) when you turn 65. This is the 7-month window that surrounds your 65th birthday. During this enrollment period, you can sign up for a Medicare Advantage plans with or without Prescription Part D coverage.

If you delayed your Part B enrollment due to having employer coverage, you can elect to enroll into Medicare Advantage under a Special Enrollment Period (SEP). To learn more about Special Enrollment periods, please go to our Medicare Enrollment page

Finally, for those already on Original Medicare and desire to switch to Medicare Advantage, Medicare offers an Annual Enrollment Period (AEP) where individuals can make this change.  AEP runs from October 15 through December 7 each year and also provides you the opportunity to change plans or drop your Medicare Advantage plan.  To learn more about the Annual Enrollment Period, please visit our Medicare Enrollment page.

Talking Points Before Purchasing a Medicare Advantage Plan

✓ A Medicare beneficiary can choose either a Medicare Supplement or a Medicare Advantage plan, but they cannot elect both.

✓ To be eligible for a Medicare Advantage plan, you must live in the plan’s service area.

✓ Medicare Advantage plans have provider networks from whom you can access care. Inquire if referrals are needed to navigate through their network of providers.

✓ Before purchasing an Advantage plan, please ask your agent to perform a provider search to confirm that your medical providers are accessible through their plans.

✓ Medicare Advantage coverage includes prescription coverage, so please have your agent evaluate your prescription list to identify the levels of coverage and costs by selecting an Advantage plan. 

✓ Ask about supplemental benefits such as vision, dental and hearing as well as gym memberships.  Medicare Advantage plans can provide benefits in these areas.