Is Medicare Advantage (Medicare Part C) Right for You?

Is Medicare Advantage Right for You?

Depending on where you live, you likely have several Medicare Advantage plans to choose from. It’s important to consider your health needs — such as the prescription drugs you take, any procedures you expect to undergo, and whether you have a primary care doctor you want to continue seeing —  before you compare your plan options.

A GoHealth licensed insurance agent can help you compare plans to find the best choice for you.

Is Medicare Advantage Better Than Original Medicare?

Medicare Advantage plans substitute for Original Medicare’s Part A and Part B coverage, but every plan is different and plan availability depends on where you live. Likewise, your costs can vary based on the plan you choose. Here are some of the pros and cons of a Medicare Advantage plan.

Medicare Advantage Pros

• Medicare Part C plans often include additional benefits like dental, hearing, vision, Medicare flex cards, and prescription drug coverage.
• Medicare Advantage premiums depend on the plan, but many only charge the monthly Medicare Part B premium.
• 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 most services under Medicare Part B.

Medicare Advantage Cons

• Medicare Advantage plans are available based on location, while you can enroll in and use Original Medicare coverage anywhere in the U.S.
• Unlike Original Medicare, which may be accepted by participating doctors across the U.S., most Medicare Advantage plans have local or regional provider networks. To get the most out of your benefits, you must go to in-network doctors and pharmacies.
• Medicare Advantage provider networks may require a doctor’s referral for specialists

Check out our guide on Medicare Advantage coverage to learn more about Part C.

Medicare Advantage vs. Medicare Supplement Plan (Medigap)

When Original Medicare doesn’t cover certain out-of-pocket expenses, Medicare Supplement plans (also known as Medigap) from private insurance carriers helps with these costs. Like Medicare Advantage plans, Medigap plans are purchased from a private insurance carrier. However, these plans charge monthly premiums on top of your Medicare Part B premium.

For many people, Medicare Advantage plans are a more affordable alternative to paying for both Original Medicare and a Medicare Supplement plan. Medicare Advantage plans may also offer helpful additional benefits that you can’t get from either Original Medicare or a Medigap plan.

Another key difference is that most Medicare Advantage plans have provider networks, which limit where you can make the fullest use of your benefits. If you frequently travel around the U.S, Original Medicare with a Medigap plan may be the right choice for you.

One thing to keep in mind about Medigap and Medicare Advantage plans:

You cannot enroll in both types of plans. You can either choose Original Medicare and add Medigap coverage or instead enroll in a Medicare Advantage plan.