Medicare Advantage
Your All-in-One Alternative to Original Medicare
Medicare beneficiaries can choose an “all-in-one” alternative to Parts A and B, known as Medicare Advantage, or Part C.
Insurance companies who sell Advantage plans must provide the same level of coverage as Original Medicare — the only exception being hospice care.
What Is Medicare Advantage?
Medicare Advantage, also known as Part C, are Medicare health plans offered by private companies such as United Healthcare, Anthem,, Humana, etc. There are other differences between Original Medicare and Medicare Advantage that you may want to know. For example, Medicare Advantage plans may offer important additional benefits such as dental, vision, hearing, and prescription drug coverage. These are things that Original Medicare does NOT cover.
Common Types of Medicare Advantage Plans
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- Medical Savings Accounts (MSAs)
- MAPD
Get the right coverage at the right price.
Who Qualifies?
It’s easy to qualify. If you’re enrolled in Original Medicare and live in the plan’s coverage area, you’re eligible for Medicare Advantage. You must stay enrolled in Parts A and B — so you’ll continue to pay your Medicare Part B premium to get healthcare benefits.
Why Join a Medicare Advantage Plan?
- Inpatient Hospital Benefits
- Outpatient Medical Coverage
- Most include Part D Drug Coverage
- Some include a fitness membership
- Low Monthly Premiums — sometimes $0
When to Enroll
During certain times of the year, you may join, drop, or change from one Advantage plan to another. When you’re first eligible for Medicare, you can join a Medicare Advantage plan with or without Part D drug coverage. This is known as your Initial Enrollment Period (IEP), and it starts the three months before the month you turn 65 and ends the three months after.
The Annual Enrollment Period (AEP), is October 15 to December 7 each year. During this period, you can join, change, or drop a Medicare Advantage plan. Coverage will kick in on January 1.
Still with us? There are more times in which you can enroll. The Medicare Advantage Open Enrollment (MAOEP) is January 1 to March 31. You can switch to a different Advantage plan or return to Original Medicare and enroll in a standalone Part D plan, once, during this window.
Also, certain events trigger a Special Enrollment Period (SEP) where you have two months to sign up for a Medicare Advantage plan. Since these are unique to the individual, it’s best to contact Oak Haven Insurance Agency to see if you qualify for an SEP.
Medicare Advantage Is Different from Medigap
Many beneficiaries sign up for Medicare Advantage plans thinking they are supplements (Medigap policies). Advantage plans are NOT supplements.
The two programs have roughly the same end result, but they go through different setups. Medicare Supplements are additional policies that you may add to your Original Medicare, while Medicare Advantage essentially replaces your Original Medicare. Before you choose a plan, we want to make sure you know the difference between Medicare Advantage and Medicare Supplements.
Is Medicare Advantage Free?
No. While it’s possible to join a plan with a $0 premium, you have to continue to pay $148.50, which is your monthly premium for Medicare Part B.
In exchange for a low premium, your Advantage plan may require you to visit doctors or specialists in their provider network. Most plans also include co-payments, coinsurance, and deductibles, which vary by plan.
Maximum Out-Of-Pocket Limit
There’s another important thing you should know. All Medicare Advantage plans set a yearly limit on your out-of-pocket expenses, known as the maximum out-of-pocket (MOOP). In 2021, this limit is $7,550, but programs may set lower limits. Under Original Medicare, there’s no limit on your spending.
Contact a Broker for Help
If you’re looking for a Medicare Advantage plan in Texas, the brokers at Oak Haven Insurance can help. One of the areas we specialize in is Medicare Advantage. When you contact us, we’ll tell you about the benefits available in your area and help you identify the type of plan that makes sense for your needs and budget. The best part? Our help doesn’t cost you anything extra. So pick up the phone, and call us today!
