Medicare Advantage

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Medicare Advantage

Medicare Advantage (Part C) is an alternative choice to Original Medicare as it combines Medicare Part A and Medicare Part B into one plan. It also often includes prescription drug coverage and may occasionally come with other benefits that one would not receive with Original Medicare.

To enroll in a Medicare Advantage Plan, you must be enrolled in Original Medicare.


Private insurance companies provide Medicare Advantage Plans as an alternative option to Medicare Part A and Medicare Part B (Original Medicare).

These plans offer similar coverage to Original Medicare but also incorporate extra advantages and other additional incentives or benefits—for example, prescription drug coverage, vision, dental, and hearing coverage. There are several plans which also incorporate health, wellness, and fitness services.


Most Medicare Advantage plans do not have a premium. However, you will still need to continue to pay your Part B premium, which is $148.50 as of 2021. If you drop your Part B coverage and stop paying its premium, you will lose your Medicare Advantage coverage. Medicare Advantage plans also have maximum out-of-pocket limits. In 2021, this limit is $7,550.

There are different Medicare Advantage plans that you may want to consider. The most common Medicare Advantage plans are Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO).

Usually, the Health Maintenance Organization (HMO) plan comes with reduced costs. However, it requires you to see providers within their network and get referrals before seeing a specialist. On the other hand, the PPO plan typically costs more but offers more flexible options for visiting providers and may not require referrals to see specialists.

Other plans include:

  • Private Fee-for-Service (PPFS) - With PFFS plans, you are not required to choose a primary care physician or get referrals for specialists. You can also typically receive care outside the plan’s network, but only if the provider accepts your plan’s terms and conditions. This plan will also choose how much they will pay the healthcare provider and how much you will pay.
  • Special Needs Plans (SNPs) - SNPs are limited to serving specific individuals who have specific needs. To qualify for an SNP, you must meet one of the following requirements:
    • You live in an institutional setting, like a nursing home
    • You are eligible for Medicare and Medicaid
    • You have a chronic or disabling condition
  • Medicare Medical Savings Account Loans (MSA) - MSAs combine a high deductible plan with a savings account. You must pay the high deductible before your plan will start providing coverage. However, the plan provider will also deposit funds into a savings account that you can use towards the deductible.

You can enroll for Medicare during one of several enrollment periods:

  • Initial Enrollment Period - This period begins three months before your 65th birthday and ends three months after, lasting for a total of seven months. This marks when you first become eligible for Medicare, but remember, you must be enrolled in Original Medicare first before you can enroll in a Medicare Advantage plan.
  • Annual Enrollment Period - Begins October 15 and ends December 7. During this period, you can make several changes to your coverage. For example, if you are enrolled in Original Medicare, you have the option to enroll in a Medicare Advantage plan. If you are enrolled in a Medicare Advantage plan, you can also switch back to Original Medicare or switch to a different Medicare Advantage plan, with or without prescription drug coverage.
  • Special Enrollment Period - There is no specific timeframe for this period, but you can qualify for it in several ways, such as if you move outside your plan’s service area and need to enroll in a new plan.
  • Medicare Advantage Open Enrollment Period - Begins January 1 and ends March 31. This period is similar to the Annual Enrollment Period in which if you are not satisfied with your Medicare Advantage plan, you can switch to a new one that does or does not have prescription drug coverage, or you can switch back to Original Medicare.

Are you interested in enrolling in a Medicare Advantage plan but unsure which plan would meet your needs best? No worries! The agents with Advocate Health Advisors are ready and willing to help.

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