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Is Medicare Advantage Right for You?

Everything you need to find the right Medicare Advantage or Part C plan

Reviewed by: Ed McClane, Licensed Insurance Agent.

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Key Takeaways

  • The Plan

    Medicare Advantage coverage includes Parts A, B, along with additional health and wellness benefits.

  • How It Works

    Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A and B)Original Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance).. Part C is a part of Medicare but purchased from private insurance companies.

  • The Value

    Along with Medicare Parts A and B, most Medicare Advantage plans include Part D,Medicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and extra health and wellness benefits.

  • How to Enroll

    You can enroll through Marketplaces like GoHealth, private health insurance companies, or by mailing a paper application to the plan you want to join.

What is Medicare Advantage?

Medicare Advantage Plans, also known as Part C, are an alternative option to Original Medicare (Parts A and B). Part C is administered by private health insurance companies that comply with Medicare guidelines. Part C provides Original Medicare benefits, extra health and wellness benefits and most include Part D medications.

Whether you’re new to Medicare or looking to change your existing plan, we want to help you choose the right plan to fit your lifestyle and budget.

What Do Medicare Advantage Plans Cover?

Medicare Advantage plans cover the same services as Original Medicare. Most Medicare Advantage enrollees receive coverage for extra benefits through their plan, including: 

74% 

Dental Benefits

79%

Vision Benefits

72%

Hearing Aids

77%

Telehealth Services [1]

Additionally, most plans include prescription drug coverage (Medicare Part D). 

Is Medicare Advantage Right for You?

Medicare Advantage data shows close to a two-fold increase in enrollment from 2010 to 2020. In 2020, 36% or 24.1 million of people enrolled in a Medicare program joined Medicare Advantage. In 2000 for comparison, 17% of all Medicare beneficiaries (6.8 million people) selected a Medicare Advantage Plan. [2]

You have options when it comes to selecting a Medicare plan. It’s essential to understand what each plan offers and compare it to your lifestyle. Let’s take a look at some of your options.

Medicare Advantage v. Medicare

What’s the difference between Medicare and Medicare Advantage Coverage?

Medicare Advantage (Part C) has Part A and Part B benefits, known as Original Medicare, and most plans include Supplemental Medication Coverage (Part D). Part C can offer lower costs with similar benefits. On the other hand, the extra coverage is less flexible.

Medicare Advantage Pros

You have the benefits of Original Medicare, and most plans have extras like prescription drug coverage (Part D).

Medicare Advantage plans can be less expensive than Original Medicare. You can find Part C plans with $0 premiums and lower copayment amounts than Original Medicare. 

They pay all medical costs after the maximum out-of-pocket limitOut-of-Pocket Maximum (OOP) is the maximum amount of money an individual will pay towards out of pocket expenses like deductibles, co-payments, and co-insurance. is exceeded for the calendar year. Original Medicare does not. [3]

Medicare Advantage Cons

Medicare Advantage may require a doctor’s referral for specialists.

Medicare Advantage is a local or regional plan 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 determine whether Part C is right for you.

Medicare Advantage v. Medigap (Medicare Supplement)

What’s the difference between Medicare Advantage and Medicare Supplement (Medigap)?

It’s essential to know that you cannot enroll in both plans and must select between one or the other. A Medicare Supplement (Medigap)Medicare Supplement Insurance (Medigap) are policies designed to provide coverage that Original Medicare (Parts A and B) do not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you'll need to pay. plan must be added to Original Medicare for unmet healthcare coverage.  

When Original Medicare misses out-of-pocket expenses like copaysA copayment (copay) is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you'll pay $20 to your doctor whenever you have an appointment., co-insuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. The remaining amount is paid by your insurance company. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you'll pay $200. Your insurance company will cover the final $800. and deductiblesA deductible is the amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself., Medigap (private insurance) will pay most of what’s left in the gap.

Bundled benefits make Part C plans a popular choice, but local/regional networks limit where you can use the plan. 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. 

Do you have questions about enrollment? Contact us.

Medicare Part C Costs

We can help you understand what costs are involved with each plan, and get you enrolled in a plan that fits your lifestyle and needs.

Let’s take a look at Part C cost information to consider:

  • Plan type.
  • Always consider the cost of monthly premiums. Some Medicare Advantage Plans do not have premiums.
  • Find out if your plan pays some or all of the Part B premium. Part B premiums can be higher or lower based on your income. In 2020, the standard Part B premium is $144.60. [3]
  • Your costs may vary if you receive MedicaidMedicaid is a state-based health insurance program based on an individual's financial needs. or financial assistance from your state government.

Don’t forget general healthcare costs 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.

How Can I Enroll in Medicare Part C?

In order to enroll in 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 Advantage enrollment.

FAQs

Are all Medicare Advantage Plans the same?

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 co-insurance 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. 

What happens to my Original Medicare plan when I enroll in a Medicare Advantage plan?

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 Annual Enrollment Period (October 15 through December 7).

Can I enroll in a separate drug plan while on a Medicare Advantage plan?

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.

Do I continue to pay my Part B premium?

You will continue to pay your Part B premiumMedicare Part B premiums cover doctor services, inpatient therapies, durable medical equipment and more. Your income plays a part in your premium. For 2020, individuals making $87,000 per year or less and couples making $174,000 or less pay the standard monthly amount of $144.60 each. ($144.60 in 2020) 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.

What's Next?