Medicare 101

Medicare Advantage Plan 101: How it compares with Original Medicare

Medicare Advantage Plans are health plan options that provide an alternative way to get your Medicare Part A and Part B coverage. Offered by private companies approved by Medicare, Medicare Advantage Plans bundle Medicare benefits along with sometimes extra benefits not covered by Original Medicare. Understanding the basics can help you decide if joining a Medicare Advantage Plan is right for your health needs and budget.

Medicare Advantage Plans have become an increasingly popular option with about 28 million people enrolled in 2022. This article will explain what Medicare Advantage Plans are, what’s covered, costs, benefits beyond Original Medicare, and help you learn what you should know about these Medicare Plan choices.

What are Medicare Advantage Plans?

Medicare Advantage, also known as Medicare Part C, are health plans from private insurance companies that contract with Medicare to provide your Part A and Part B benefits. When you join a Medicare Advantage Plan, you still have Medicare but your coverage is provided through the private plan rather than Original Medicare.

These plans include:

  • HMOs (Health Maintenance Organizations)
  • PPOs (Preferred Provider Organizations)
  • PFFS (Private Fee-for-Service)
  • SNPs (Special Needs Plans)

Each type works a bit differently in terms of networks, referrals, and how you get care. The key point is that all plans must provide at least the same coverage as you get with Original Medicare.

What Do Medicare Advantage Plans Cover?

Medicare Advantage Plans must provide the same services that Original Medicare covers, including:

  • Hospital stays
  • Doctor visits
  • Preventive services
  • Emergency care
  • Prescription drugs
  • Other certain services

Many Medicare Advantage Plans also provide coverage for extra benefits not covered by Original Medicare like vision, hearing, dental, and more. The costs and additional benefits can vary greatly between plans, so it’s important to understand coverages.

Plans have a yearly limit on your out-of-pocket costs for Part A and B covered services. Once you reach the plan’s limit, you’ll pay nothing for covered services for the rest of the year. Cost sharing amounts like copays and deductibles vary by plan.

What Are the Benefits of Medicare Advantage Plans?

Benefits of Medicare Advantage Plans include:

Lower Out-of-Pocket Costs

Many Medicare Advantage Plans have lower copays, deductibles and other out-of-pocket costs for services than what you’d pay with Original Medicare. Each plan is different so compare options.

Extra Benefits

Most plans include vision, hearing, dental, gym memberships and other benefits not covered by Original Medicare. These extra benefits can improve your health.

Prescription Drug Coverage

Many Medicare Advantage Plans include Part D prescription drug coverage which provides savings on your medications. With Original Medicare you have to enroll separately in a Part D Plan.

Yearly Limit on Costs

Medicare Advantage Plans limit how much you have to pay out-of-pocket each year for covered medical services. With Original Medicare, your costs have no limit.

Coordinated Care

Medicare Advantage Plans often provide coordinated, integrated care designed to keep you healthier. Many plans assign you a primary care doctor.

What Do Medicare Advantage Plans Cost?

Medicare Advantage Plan costs include:

  • Monthly premium – Many plans have a $0 premium but some do charge a monthly premium. The average is around $20 per month. You must continue paying your Part B premium.
  • Copays – The copay amount varies by the service but is often less than you’d pay with Original Medicare. Copays apply each time you receive a covered service.
  • Deductibles – Some plans have an annual deductible you pay first before coverage kicks in, but it’s usually lower than Original Medicare’s deductibles if your plan has one.
  • Coinsurance – The coinsurance percentage you pay for services after meeting your deductible is typically lower than what you’d pay with Original Medicare.
  • Part D premium – If drug coverage is included you’ll pay a monthly premium that averages around $33 per month.

Keep in mind costs vary significantly between Medicare Advantage Plans so compare carefully before choosing a plan.

Key Differences from Original Medicare

While Medicare Advantage Plans cover everything Original Medicare covers, there are some key differences:

  • Original Medicare is managed directly by the federal government. Medicare Advantage Plans are from private insurance companies approved by Medicare.
  • Original Medicare allows you to see any doctor that accepts Medicare nationwide. Medicare Advantage Plans have provider networks you must use.
  • You can see any specialist you choose with Original Medicare without referrals. Some Medicare Advantage Plans require you to get a referral to see specialists.
  • Original Medicare covers you everywhere in the U.S. Medicare Advantage Plans only cover you in their service area unless it’s an emergency.
  • Original Medicare has no annual limit on your out-of-pocket costs. Medicare Advantage Plans limit how much you pay annually for covered medical services.

Should I Get a Medicare Advantage Plan?

Medicare Advantage Plans make sense for many beneficiaries but aren’t right for everyone. They can provide advantages through lower costs, extra benefits, and coordinated care. But provider choice is more restricted.

If you have complex health needs, you may do better under Original Medicare. If you want lower costs and are comfortable with a provider network, a Medicare Advantage Plan may be preferable. Review your options carefully before deciding.

What Should You Know About Medicare Advantage?

Here are some key things to know about Medicare Advantage Plans:

  • They include all Medicare Part A and Part B coverage through private insurance companies
  • Many cover extras like vision, dental, hearing aids
  • Most include prescription drug coverage
  • Yearly limit on your out-of-pocket costs for covered medical services
  • Plans have provider networks you must use
  • Monthly premiums and healthcare costs are often lower
  • Not right for everyone – compare to your needs
  • Enroll during Medicare’s Annual Election Period October 15 to December 7

While not right for everyone, Medicare Advantage Plans are worth understanding as an alternative to get your Medicare coverage. Evaluating your choices allows you to find the best medical and prescription drug coverage for your healthcare needs and budget.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Manatee Insurance Solutions a Call at (352) 221-3779. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.


Does Medicare pay anything if you have an Advantage Plan?

 Yes, Medicare pays a certain amount to the Advantage Plan to cover your healthcare costs. However, the amount may vary depending on the plan you choose and the services you receive. You may still be responsible for out-of-pocket costs.

What are the out-of-pocket costs associated with Medicare Advantage Plans?

 Out-of-pocket costs for Medicare Advantage Plans can include deductibles, copayments, and coinsurance for covered services. These costs can vary depending on the specific plan and the services you receive.

Are all health plans covered by Medicare?

 No, not all health plans are covered by Medicare. Medicare Advantage Plans are Medicare health plans offered by private insurance companies that are approved by Medicare. These plans are an alternative to Original Medicare and provide the same Medicare benefits.

Can Medicare Advantage Plans offer additional benefits that Original Medicare does not cover?

 Yes, Medicare Advantage Plans may offer additional benefits that are not covered by Original Medicare. These additional benefits can include prescription drug coverage, dental services, vision care, hearing aids, and fitness programs, among others.

 Are Medicare Advantage Plans the same as Medicare Part C?

 Yes, Medicare Advantage Plans are also known as Medicare Part C plans. Medicare Part C is an alternative way to receive your Medicare Part A and Part B benefits through a private insurance company.

Are Medicare Health plans required to offer Medicare Part B coverage?

 Yes, Medicare Advantage Plans are required to offer at least the same level of coverage as Original Medicare, which includes Medicare Part B benefits. However, the specific coverage and costs may vary depending on the plan.

 Can I have a Medicare drug plan if I have a Medicare Advantage Plan?

 No, you cannot have a separate Medicare drug plan if you have a Medicare Advantage Plan. Most Medicare Advantage Plans include prescription drug coverage, so you generally do not need a separate drug plan.

Do Medicare Advantage Plans have premiums?

 Yes, Medicare Advantage Plans can have premiums. In addition to your Part B premium, you may need to pay an additional premium for your Medicare Advantage Plan. However, some Medicare Advantage Plans have $0 premiums.

Can I receive coverage for services not covered by Medicare Part A and Part B through a Medicare Advantage Plan?

 Yes, Medicare Advantage Plans may offer coverage for services not covered by Medicare Part A and Part B. These plans may also offer additional benefits like dental services, vision care, and prescription drugs. However, it is important to review the specific coverage options of each plan.

 Do I need to participate in Medicare to enroll in a Medicare Advantage Plan?

Yes, to enroll in a Medicare Advantage Plan, you must be eligible for Medicare and enrolled in both Part A and Part B. Medicare Advantage Plans follow the rules set by Medicare and provide the same benefits as Original Medicare.