Medicare Advantage Plans

Medicare Advantage (Part C) replaces Original Medicare Parts A and B with a private insurance plan. Most include prescription drug coverage (Part D) plus extra benefits like dental, vision, and hearing that Original Medicare doesn't cover.

Available once you turn 65 or qualify for Medicare due to disability.

All-in-One Coverage
Medical, hospital, and usually prescription drugs in one plan with one card.

Extra Benefits Original Medicare Doesn't Cover
Dental, vision, hearing aids, over-the-counter allowances, gym memberships, transportation to appointments.

Out-of-Pocket Maximum
Your costs are capped each year. Original Medicare has no cap.

$0 Premium Plans Available
Many plans have $0 monthly premium (you still pay your Part B premium to Medicare).

Predictable Costs
Set copays instead of Original Medicare's 20% coinsurance with no limit.

Medicare Advantage:

• One plan covers everything
• Extra benefits included
• Out-of-pocket maximum protection
• Often $0 premium
• Must use network providers (HMO) or pay more out-of-network (PPO)

Original Medicare + Medigap:

• See any doctor that accepts Medicare
• No networks or referrals
• More predictable costs with Medigap
• Must buy separate Part D for prescriptions
• Medigap premiums can be $100-$300/month

We'll show you both options with actual costs.

HMO (Health Maintenance Organization)

• Lowest costs
• Must use network doctors
• Need referrals for specialists
• No out-of-network coverage except emergencies
• Best for those who want low costs and don't mind network restrictions

PPO (Preferred Provider Organization)

• Higher premiums
• Can see out-of-network doctors (costs more)
• No referrals needed
• More flexibility
• Best for those who want provider choice

HMO-POS (Point of Service)

• Hybrid of HMO and PPO
• Some out-of-network coverage for certain services

Everything Original Medicare covers:
✓ Doctor visits
✓ Hospital stays
✓ Lab tests and X-rays
✓ Preventive care
✓ Medical equipment

Plus extra benefits like:
✓ Prescription drug coverage
✓ Dental (cleanings, fillings, sometimes dentures)
✓ Vision (eye exams, glasses/contacts allowance)
✓ Hearing aids
✓ Over-the-counter allowance ($50-$200/month for items like vitamins, pain relievers, first aid)
✓ Fitness membership (gym, SilverSneakers)
✓ Transportation to medical appointments
✓ Meal delivery after hospital stays
✓ Telehealth visits

Benefits vary by plan. We'll show you what each plan includes.

You must:

Have Medicare Part A and Part B

Live in the plan's service area

Not have End-Stage Renal Disease (ESRD) - with some exceptions

Most people get Medicare at age 65. Some qualify earlier due to disability or certain conditions.

Initial Enrollment (when you first get Medicare):
7-month period around your 65th birthday - 3 months before, your birthday month, and 3 months after.

Annual Enrollment Period:
October 15 - December 7 every year. Coverage starts January 1.

Medicare Advantage Open Enrollment:
January 1 - March 31. Switch Medicare Advantage plans or return to Original Medicare.

Special Enrollment Periods:
Moved out of service area, lost other coverage, qualify for Extra Help, certain other circumstances.

Monthly Premium:
Many plans: $0 (you still pay Part B premium to Medicare, currently $185/month)
Some plans: $20-$100/month extra

Deductibles:
Medical: $0-$500
Prescription: $0-$500

Copays:
Primary care: $0-$25
Specialists: $20-$50
Generic drugs: $0-$10
Hospital: $200-$400 per day

Out-of-Pocket Maximum:
$3,000-$8,000/year (after this, plan pays 100%)

Your costs depend on the plan and your location.

Most Medicare Advantage plans include Part D prescription coverage.

Drug Tiers:
Tier 1 (Generic): $0-$10 copay
Tier 2 (Preferred Brand): $20-$47
Tier 3 (Non-Preferred Brand): $47-$100
Tier 4 (Specialty): 25%-33% coinsurance

We'll check if your medications are covered and at what cost before you enroll.

If your income is limited, you may qualify for Extra Help that lowers prescription costs:

Income limits (2025):
Individual: $22,590
Married couple: $30,660

Asset limits:
Individual: $17,220
Married couple: $34,360

Extra Help can reduce drug costs to $0-$4 per prescription. We'll help you apply.

"Can I keep my current doctor?"
Depends on the plan. Check if your doctor is in the network before enrolling. We'll verify this for you.

"What if I travel or spend winters in another state?"
PPO plans offer more flexibility. Some plans have nationwide networks. Emergency care is covered everywhere.

"Can I switch plans if I don't like it?"
Yes, during Annual Enrollment (Oct 15-Dec 7) or Medicare Advantage Open Enrollment (Jan 1-Mar 31).

"Do I need a Medigap plan with Medicare Advantage?"
No. In fact, you can't have both. It's one or the other.

"What happens if I need care out-of-network?"
HMO plans don't cover it except emergencies. PPO plans cover it but you pay more.

1. Check your doctors and hospital
Make sure they're in the network

2. Review your prescriptions
Confirm your drugs are covered and check costs

3. Consider extra benefits
Which dental, vision, hearing benefits matter to you?

4. Compare costs
Premium + deductible + copays + out-of-pocket max

5. Read the Star Ratings
Medicare rates plans 1-5 stars based on quality and service

We'll walk you through all of this and recommend the best options for your situation.

1. Get Your Quote
Call 800-835-1776 - we'll compare all plans in your area

2. Review Your Options
We'll show you 3-5 plans that fit your doctors, drugs, and budget

3. Check Doctor and Drug Coverage
We'll verify everything before you enroll

4. Complete Application
Usually approved within 24-48 hours

5. Coverage Starts
Effective date depends on when you enroll

No cost for our help. We're paid by the insurance companies.

CALL NOW: 800-835-1776
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