Is Medicare Advantage (Medicare Part C) Right for You?
Reviewed by: Ed McClane, Licensed Insurance Agent
Medicare Advantage plans are private insurance and provide Part A and Part B coverage. Most Medicare Advantage plans include Part D along with dental, vision and hearing benefits.
Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A & B benefits or coverages as Original Medicare. Along with receiving Part A & B benefits, Medicare Part C often bundles your benefits with additional ones like dental, hearing, vision and prescription drug coverage.
Along with Medicare Parts A and B, most Medicare Advantage plans include Part D, and extra health and wellness benefits. Most Medicare Advantage plans can offer lower monthly premiums and out-of-pocket maximums.
You can enroll through Marketplaces like GoHealth, private health insurance companies, or by mailing a paper application to the plan you want to join.
When you have Medicare Part C, your Part C benefits ID card replaces your Medicare ‘Red, White & Blue’ card at every visit.
Medicare Advantage (Part C) is private health insurance that complies with Medicare guidelines. Part C provides Part A and B coverage, and extra health and wellness benefits and most include a Part D prescription drug plan.
Whether you’re new to Medicare or looking to change your existing plan, we want to help you choose a plan to fit your lifestyle and budget.
Find a local Medicare plan that fits your needs
Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A & B benefits or coverages as Original Medicare. A high percentage of Medicare Advantage plans also offer extra benefits, including:
offer dental benefits
offer vision benefits
offer hearing aids
offer telehealth services
Additionally, most plans include prescription drug coverage (Medicare Part D).
Depending on where you live, it is likely that you’ll have several Medicare Advantage plans to choose from. It’s important to know your health needs before you compare your plan options. It’s essential that your doctors and prescriptions are covered in your Medicare Advantage plan. A GoHealth licensed insurance agent can help you compare plans to find one that meets your needs.
Is Medicare Advantage Better Than Original Medicare?
Medicare Advantage and Original Medicare offer Part A and Part B, but your health needs and location can affect the benefits you receive from each. Likewise, your costs can vary based on whether you choose a Medicare Advantage plan or Original Medicare. Here’s a look at some of the pros and cons of a Medicare Advantage plan.
Medicare Advantage Pros
- Along with receiving Part A & B benefits, Medicare Part C often bundles your benefits with additional ones like dental, hearing, vision, and prescription drug coverage.
- Medicare Advantage premiums can be more affordable than Original Medicare. Some Medicare Advantage plans offer $0 premiums and lower copayment amounts than Original Medicare.
- Medicare Advantage plans offer an out-of-pocket maximum. Once you reach the maximum amount for out-of-pocket cost sharing, your plan will pay 100% of your costs for the remainder of the plan’s calendar year. Original Medicare does not have an out-of-pocket maximum. You will always be responsible for at least 20% of the cost of services.
Medicare Advantage Cons
- Medicare Advantage networks may require a doctor’s referral for specialists.
- Medicare Advantage plans are available based on location, with in-network providers and facilities. Services outside of the network generally are not covered by the plan.
- Original Medicare’s provider network extends across the U.S. anywhere Medicare is accepted.
Check out our guide on Medicare Advantage coverage to learn more about Part C.
Medicare Advantage vs. Medicare Supplement plan (Medigap)
When Original Medicare misses out-of-pocket expenses like copays, co-insurance and deductibles, Medigap (private insurance) will pay most of what’s left in the gap.
However, bundled benefits make Medicare Advantage (Part C) plans a popular choice. Most Medicare Advantage plans bundle Part A and Part B with Part D and extras benefits like vision, dental, and hearing.
Keep in mind, local/regional networks limit where you can use your Medicare Advantage plan. So if you like to travel around the U.S. during the year, Original Medicare with a Medigap plan may be the right choice for you.
One thing to keep in mind about a Medigap and Medicare Advantage plan:
You cannot enroll in both plans. You must choose Original Medicare and add Medigap coverage or instead choose a Medicare Advantage plan.
Are you eligible for cost-saving Medicare subsidies?
We can help you understand what costs are involved with each plan.
Let’s take a look at Part C cost information to consider:
- There are several options when choosing a Medicare Advantage plan. Selecting the right plan for your needs is critical.
- Typically, Medicare Advantage plans have a monthly premium but some Medicare Advantage Plans do not have premiums.
Don’t forget general healthcare costs TRUSTED & VERIFIED healthcare.gov when you select your plan. Typical cost factors include:
- Annual deductible, copayment, co-insurance and out-of-pocket maximum amounts of all services or needs.
- Is your current provider in the plan’s network of providers? Call your provider’s office or a GoHealth TeleCare team member to find out.
- Consider your care plan and visit frequency.
- Associated costs for additional needed benefits.
In order to enroll or switch to a Medicare Advantage plan, you must first be enrolled in Medicare Part A and Part B through Social Security. Then you should contact a private insurance company to enroll in Medicare Advantage, or you can enroll by mail after completing paper enrollment forms. You can also contact a licensed insurance agent with GoHealth, who will walk you through the enrollment process and answer any questions about finding the right plan for you. Learn more about how to navigate Medicare Part C enrollment.
What extra benefits and savings do you qualify for?
Medicare Advantage coverage varies and is specific to where you live. Policy premiums range from as low as $0 to as high as $300. No Medicare Advantage Plans are the same. Your plan may have different deductibles, copayments and coinsurance terms. All policies must offer the same coverage level as Part A and Part B, but many offer more benefits. It’s important to compare plans to see what best fits your needs.
You will not lose your Original Medicare plan when you enroll in Medicare Advantage. In fact, you must have Medicare Part A and B before enrolling in Medicare Advantage. The private insurance company will manage your Medicare benefits. You can switch from Medicare Advantage and return to Original Medicare during the Medicare Open Enrollment Period, also called the Annual Enrollment Period (October 15 through December 7).
You can enroll in a separate drug plan if your current plan doesn’t offer drug coverage. A separate drug plan option is available only with Medicare Medical Savings Account and Private Fee For Service plans. Give your plan careful review before joining a separate Part D Plan. If you have a Part C HMO or PPO plan and enter a separate Part D plan, Medicare will unenroll you from Part C and enroll you in Original Medicare.
You will continue to pay your Part B premiumMedicare Part B premiums are monthly fees paid in exchange for coverage of doctor services, inpatient therapies, durable medical equipment and more. You may have to pay more than the standard Part B premium if you are high-income. unless you are a Medicaid recipient, receive assistance from Social Security or your State, or have a plan that reimburses some or all of the Part B premium payment.