What is Medicare Advantage?
What is Medicare Advantage?
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare offered through private insurance companies approved by Medicare. These plans combine Part A (hospital) and Part B (medical) coverage into one plan—and many also include Part D (prescription drug coverage), along with extra benefits like dental, vision, hearing, and wellness programs. Medicare Advantage plans often operate within a provider network, which means you may need to see doctors and specialists within that network. These plans can be a great choice if you're looking for all-in-one coverage, but it's important to compare options carefully based on your health needs, budget, and preferred doctors. We’re here to help you sort through the details and find a plan that fits your lifestyle.
Who is Eligible for a Medicare Advantage Plan?
Medicare Advantage is available to anyone who is enrolled in both Medicare Part A and Part B and lives within the service area of the plan they’re considering. Enrollment is only open during specific times of the year, like your Initial Enrollment Period when you first become eligible, or the Annual Enrollment Period each fall.
When Can I Enroll in a Medicare Advantage Plan?
Knowing when you can enroll in a Medicare Advantage plan is key to making sure you get the coverage you need, when you need it. There are several specific enrollment periods to be aware of:
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Initial Enrollment Period (IEP): This is your first chance to enroll in Medicare. It starts three months before the month you turn 65, includes your birthday month, and continues for three months after—a total of seven months. If you’re under 65 and qualify due to a disability, your IEP will begin once you’ve received disability benefits for 24 months.
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Annual Enrollment Period (AEP): From October 15 to December 7 each year, you can enroll in, switch, or drop a Medicare Advantage plan. Any changes you make during this time take effect on January 1 of the following year.
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Medicare Advantage Open Enrollment Period: Between January 1 and March 31, if you’re already enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare.
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Special Enrollment Periods (SEPs): Certain life events—like moving to a new area, losing other health coverage, or qualifying for Medicaid—may give you the opportunity to make changes to your Medicare Advantage plan outside of the standard enrollment windows.
If you’re unsure which enrollment period applies to you, we’re here to help you navigate your options and find a plan that fits your needs.
Types of Medicare Advantage Plans
Medicare Advantage plans come in several types, each designed to meet different health and lifestyle needs. While all of them provide the same basic coverage as Original Medicare (Parts A and B), they vary in cost, provider networks, and flexibility. Here's a quick overview of the most common types:
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Health Maintenance Organization (HMO) Plans: HMO plans typically require you to use a network of doctors and hospitals for your care, and you’ll usually need a referral to see a specialist. These plans often have lower out-of-pocket costs and may include extra benefits like dental, vision, and prescription drug coverage.
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Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility when it comes to choosing healthcare providers. You can see specialists without a referral and go outside the network—though staying in-network will usually cost less. These plans are a good fit if you want more choice and don’t mind slightly higher premiums.
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Private Fee-for-Service (PFFS) Plans: PFFS plans determine how much they’ll pay healthcare providers and how much you’ll pay for services. You can typically see any Medicare-approved provider who agrees to the plan’s terms, which can offer more flexibility than an HMO.
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Special Needs Plans (SNPs): SNPs are tailored for individuals with specific health conditions or needs, such as diabetes, chronic heart failure, or those who are eligible for both Medicare and Medicaid (dual-eligibles). These plans offer focused care coordination and services designed for your unique situation.
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Medical Savings Account (MSA) Plans: These combine a high-deductible health plan with a medical savings account. Medicare deposits money into your account, which you can use to pay for healthcare services. These plans usually don’t include prescription drug coverage, so a separate Part D plan may be needed.
Each type of Medicare Advantage plan has its own pros and cons, so it’s important to compare your options based on your healthcare needs, budget, and preferred doctors or facilities. We’re here to help you find the right fit.
Medicare Advantage Plans for Veterans
If you’re a veteran receiving healthcare through the VA, you may wonder if a Medicare Advantage plan is right for you—and in many cases, the answer is yes. While VA benefits provide excellent care, they’re typically limited to VA facilities. A Medicare Advantage plan can complement your VA coverage by giving you access to a broader network of doctors, specialists, and hospitals outside the VA system.
Medicare Advantage plans often include additional benefits that the VA doesn’t cover, such as dental, vision, hearing, or fitness programs (such as a SilverSneakers membership). Some plans are designed specifically with veterans in mind and offer low or no monthly premiums, no referrals to see specialists, and coverage that works alongside your VA benefits—without interfering with them.
It’s important to know that enrolling in a Medicare Advantage plan will not affect your VA health benefits. Instead, it gives you more flexibility and options for care, especially if you need services when you're traveling or if you prefer to seek care outside of the VA network. We’re here to help you explore your options and find a plan that works for you.
Why You Should Review Your Medicare Advantage Plan Each Year
Even if you’ve been satisfied with your plan this year, it’s crucial to review your coverage annually during the Annual Enrollment Period (October 15 – December 7).
Here’s why an annual review is so important:
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Plans Can Change Every Year: Medicare Advantage plans often make adjustments to premiums, copays, deductibles, and out-of-pocket maximums. What was affordable this year might not be next year—and a quick review can help you avoid surprise costs.
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Your Doctors and Hospitals May No Longer Be In-Network: Plans sometimes change their provider networks. If your preferred doctors or specialists are no longer covered, you could face higher out-of-pocket costs or have to switch providers.
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Drug Coverage Can Vary: Many Medicare Advantage plans include Part D prescription coverage, but the list of covered drugs (formulary) and the cost of those medications may change from year to year. This is especially important if your prescriptions have changed or if the plan alters drug tiers and pharmacy networks.
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Your Health Needs May Have Changed: If you’ve been diagnosed with a new condition or had a shift in your healthcare needs, a different plan might offer better coverage, lower costs, or more helpful extra benefits.
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New Plans or Benefits May Be Available: New plans may offer different rates, improved benefits, or broader provider networks—sometimes even with lower premiums.
Reviewing your plan each year gives you peace of mind and ensures you're still getting the best value and coverage for your unique health needs. Working with a licensed Medicare agent can help you make sense of any changes, compare options, and choose a plan that fits your needs. Reach out to us for a no-cost, no-obligation consultation!
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We’re here to walk you through the process step by step, answer your questions along the way, and help you understand all of your options in a way that actually makes sense. Our goal is to make things simple, clear, and stress-free—so you can feel confident about the choices you’re making.