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What Is Medicare Advantage?
Medicare Advantage (Part C) is an alternative program to Original Medicare (Part A & B), managed by private insurance companies. If you already have Part A & B, This program may help you enhance your benefits, lower certain costs, and access more comprehensive healthcare options.
Monthly premium
Many plans have premiums as low as $0, depending on your area and plan choice.
Preventive care
Most plans cover preventive services like annual checkups and screenings at no cost when you use in-network providers.
Dental, vision and hearing
Many plans include dental, vision, and hearing coverage, often at low or no additional cost.
Prescription drugs
Most plans include prescription drug coverage to help lower your out-of-pocket medication costs.
Understanding Medicare Parts
Medicare has 4 main parts. Understanding each part will help you make the right decisions for your health and finances
Medicare Part A
If you need hospitalization, home care, or hospice care, Part A helps cover the costs for you.
Main Benefits:
- Hospitalization and accommodation costs
- Home health care
- Care at skilled nursing facilities
- Hospice services (end-of-life care)
Medicare Part B
Part B covers services like doctor visits, lab tests, and preventive care. Remember, it requires a monthly premium and covers 80% of approved costs once your deductible is met.
Main Benefits:
- Doctor visits and specialist consultations
- Outpatient services
- Lab tests and diagnostic imaging (MRI, X-ray, lab tests)
- Necessary medical equipment (wheelchairs, ventilators, etc.)
- Preventive services (vaccinations, regular health screenings)
Medicare Part C
If you want all-in-one coverage through a private insurer that includes Parts A and B (and usually D), Medicare Advantage (Part C) might be suitable for you.
Main Benefits:
- Includes all benefits of Part A and Part B
- Usually includes Part D (prescription drugs)
- Dental, vision, hearing
- Fitness and wellness programs (e.g., SilverSneakers)
- Transportation assistance to medical appointments
- Additional health services depending on the plan
Medicare Part D
If you use prescription medications every month, Part D will help you save on medication costs.
Main Benefits:
- Covers prescription drug costs
- Diverse drug formulary to choose from
- Multiple drug tiers to optimize costs
Who Can Enroll?
Good news: Individuals who are eligible can join a Medicare Advantage plan, but only during certain enrollment periods or if they qualify for a Special Enrollment Period (SEP)
Meet the basic eligibility requirements
- At least 65 years old, or turning 65 within 3 months
- Already have Medicare Part A and Part B when required
- Live in the plan’s service area
Special circumstances
- You moved to a new residence outside your current plan’s area
- You lost other health coverage (such as employer-sponsored) or gained Medicaid/Extra Help
- You’re newly eligible and in your Initial Enrollment Period
Note: Eligibility does not mean you can enroll any time without limitation.
Be sure to check your specific enrollment window and SEP eligibility
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Choosing the right Medicare insurance isn’t only about finances, it’s about protecting your health and your family’s future. Our team is committed to offering clear, reliable guidance and ensuring your best interests are always our top priority.
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Frequently Asked Questions
Is Medicare Advantage better than Original Medicare?
It depends on individual needs. Medicare Advantage typically offers more benefits (dental, vision, prescription drugs) with lower costs and an annual out-of-pocket maximum limit.
Can I change my insurance plan?
Yes, during the Open Enrollment period (October 15 - December 7 annually) or when you have a special life change (Special Enrollment Period).
What if I'm not satisfied with Medicare Advantage?
You can return to Original Medicare during the Medicare Advantage Open Enrollment period (January 1 - March 31) or in other special circumstances.
What are the actual costs?
It depends on the plan you choose and your health status. Many plans have $0 monthly premiums, and you only pay copays when using services. We will calculate the specifics for you.
Can I keep my current doctor?
It depends on the plan's provider network. We will check whether your doctor is in the network before enrollment.
Does Medicare Advantage include prescription drugs?
Most Medicare Advantage plans include prescription drug coverage (Part D). We will check whether the medications you are currently taking are covered.
Do I need a health exam to enroll?
No, Medicare Advantage does not require a health exam or deny coverage due to pre-existing conditions. However, you need to enroll during the designated enrollment periods.
What if I travel or visit my children in another state?
Most Medicare Advantage plans have nationwide emergency coverage. Some plans also have benefits for international travel. We will recommend a suitable plan if you travel frequently.
How do I know which plan is best for me?
This depends on many factors: your health status, medications you're taking, preferred doctors, budget, and personal needs. We will conduct a thorough analysis to find the optimal plan for you.