Is Medicare Advantage (Medicare Part C) Right for You?
Key Takeaways
Medicare Advantage plans (also called Medicare Part C) from private insurance carriers substitute for Original Medicare (Part A and Part B) coverage. Most Medicare Advantage plans include Part D prescription drug coverage, and they may offer additional benefits like dental, vision, and hearing.
Medicare Advantage plans set an out-of-pocket maximum for your annual healthcare spending. Monthly premiums vary by plan, but many people pay only the cost of their Medicare Part B premium.
You can enroll through a health insurance marketplace like GoHealth, by contacting a private health insurance carrier, or by mailing a paper application to the plan you want to join.
When you have a Medicare Advantage plan, your Part C benefits ID card replaces your red, white, and blue Medicare card.
What Is Medicare Advantage?
Medicare Advantage (Part C) is private health insurance that complies with federal guidelines guidelines. Part C plans substitute for Original Medicare’s Part A and B coverage and may offer additional health and wellness benefits. Most include Medicare Part D prescription drug coverage.
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.
What Do Medicare Advantage Plans Cover?
Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B), offering matching benefits and coverage. A high percentage of Medicare Advantage plans also offer other benefits, including:
97%
offer dental benefits
99%
offer vision benefits
98%
offer hearing benefits
83%
offer telehealth services
Additionally, most plans include prescription drug coverage (Medicare Part D).
Is Medicare Advantage Right for You?
Depending on where you live, it is likely that you 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 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, 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 take full advantage 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 like vision and dental 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.
Medicare Part C Costs
Every Medicare Advantage plan has its own costs, so it’s important to dig into the details. When you look at Part C cost information, consider these factors:
- How much will you pay in monthly premiums?
- What is the annual deductible amount for medical expenses that you need to reach before your plan starts to pay?
- How much will you pay in coinsurance and copayments when you use medical services?
- What will be the cost for a regular supply of any prescription drug you take?
- What is the maximum that you will pay out of pocket before your plan begins to pay 100% of costs
- Is your current doctor in the plan’s provider network? Check with your doctor’s office to confirm; seeing out-of-network providers can be much more expensive.
- How often do you expect to visit the doctor, and do you expect any major procedures or long-term care?
- How much will you pay to use additional benefits like dental, vision, and hearing?
A licensed insurance agent can help you understand the costs involved in all your Medicare Advantage options.
How Can I Enroll in Medicare Part C?
In order to switch to a Medicare Advantage plan, you must first be enrolled in Medicare Part A and Part B. You can contact a private insurance company directly to join a plan or complete the necessary forms and enroll by mail.
To review a range of Medicare Advantage plans, you can use a health insurance marketplace like GoHealth. Compare your options and work with a licensed insurance agent who will walk you through the enrollment process and answer any questions.
Learn more about how to navigate Medicare Part C enrollment.
