Medicare Advantage Plans

MEDICARE

Advantage Plans

As a Medicare Beneficiary, you have two ways to receive your Medicare benefits; 1. Directly through the government (Original Medicare). 2. From a private plan available in your area. Medicare Advantage, also known as “Part C”, are health plans provided by private insurance carriers. Medicare Advantage plans do not supplement your Medicare, they become it. Medicare Advantage Plans provide the same medical benefits as Original Medicare, but will usually include extra coverage. These extra’s can include prescription, dental, vision, and fitness club benefits. Medicare Advantage plans will also include manageable co-pays for medical care with caps on your annual out of pocket. Things that regular Medicare doesn’t provide. The good news is that in many cases you can get all of these benefits for little or no extra monthly premium than what you’ll pay for Medicare.

Medicare Advantage Plans

BENEFITS

Extra Benefits Included

Medicare Advantage includes medical benefits under parts A & B and may also include prescription, dental, vision, hearing, & other benefits. All in one plan.

Financial Protection

With Medicare Advantage you can access medical care for reasonable copays and you’ll have limits to the amount you spend on medical care.

Low Monthly Cost

You can get the extra benefits included with Medicare Advantage, for little or no extra monthly cost. Typically you only pay the standard monthly cost.

MEDICARE ADVANTAGE PLAN TYPES

Medicare Advantage Plans have networks, which are lists of doctors and hospitals who participate in the plan. These networks can give Medicare Advantage members convenient access to medical care at reasonable costs. There are various types of Medicare Advantage Plans and the two most common are HMO’s and PPO’s. Here are the key features and differences between the two types of plans.

PPO – Preferred Provider Organization
HMO – Health Maintenance Organization

MEDICARE ADVANTAGE VS ORIGINAL MEDICARE

As mentioned above, you have two ways to receive your primary Medicare benefits; Medicare Advantage and Original Medicare. The chart below gives you a comparison of the main features.

Feature
Original Medicare
Medicare Advantage
Total Monthly Cost Estimate
$164.90 in 2023
$104.90 – $164.90 in 2023
Part A & B Medical Included?
Yes
Yes
Cap On Annual Medical Bills Included
(Max out of pocket protection)
No, you can buy a Medicare Supplement (Medigap)
Yes
Doctor Networks
No – Open
Yes
Pharmacy Benefits (Part D)?
No, you can buy a Part D plan.
Yes, Part D is usually included, unless you choose a plan without it.
Dental, Vision, Hearing
No
Yes, typically included.
Fitness Membership
No
Yes

SAMPLE MEDICARE ADVANTAGE PLAN

What A Typical Medicare Advantage Plan Can Look Like
Benefit
Copy or Allowance
Annual Deductible
$0
Preventive Medicine
$0 copays
Doctor Visits
$5 Copay Primary Care
$30 Copay Specialist
Outpatient Surgery & Procedures
$150 – $300 copay
Hospital Stay
$100 – $300 copay per day for days 1-5, $0 copay each day above 5
In Network Max Out Of Pocket Protection
(The most you pay for medical care annually)
$3,400 – $6,700
Pharmacy Benefits (Part D)?
Generic: $0 deductible / $0 – $10 copay
Brand: $0 – $200 deductible / $40 copay
Dental
Coverage for cleanings, fillings, crowns, dentures, and other services, $2,000 – $3,000 in annual benefits
Vision
$0 cost annual eye exam, $200 allowance for eye glasses or contacts.
Hearing
$0 cost annual hearing exam, allowance or copay for hearing aids.
Gym / Fitness
Silver Sneakers membership for free access to participating gyms
Other Possible Benefits
Over the counter medicine & vitamins, flex spending cards, transportation.

*The benefits and comparisons listed in the two charts above are for general information purposes. They do not represent specific plans and benefits are not guaranteed. For plans you are considering, review the Summary of Benefits and Evidence of Coverage. Contact us for specific plan options available to you.

WHO CAN BENEFIT FROM MEDICARE ADVANTAGE?

Frequently Asked Questions

There are two primary periods when you can enroll in a Medicare Advantage plan. 1. When you first start Medicare A & B. 2. During the Annual Open Enrollment period which begins October 15th and lasts through December 7th. There may also be other special situations that make you eligible. To get information and enroll in a plan, simply contact us on this site or give us a call at 855.625.7633 toll free.

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