Medicare Advantage Plan: Is It Right For You?

Are you getting ready to enroll in Medicare and considering a Medicare Advantage Plan? Original Medicare provides excellent coverage, but it’s usually not enough.  Many people turn to a Medicare Advantage Plan for more comprehensive coverage.  Medicare Part C or Medicare Advantage acts in a unique way.  In some ways, it is similar to a Medicare Supplement Plan but it also encompasses prescription drug coverage, which usually requires Medicare Part D.  Very often, Medicare Advantage covers additional services such as:

  • Dental
  • Vision
  • Hearing
  • Even gym memberships! 

These additional perks can make Medicare Advantage quite appealing.  But is it right for you?  Honestly, it just depends!  There are various factors to take into consideration such as:

  • Your preferred doctors and hospitals
  • Your specific health needs
  • Your financial situation 
  • Even the state that you live in 

These factors can all come into play when deciding what type of Medicare coverage is right for you.  If you’d like to research the plans available to you, you can access the plan finder on Medicare.gov, but given the myriad of options available, we recommend you work with a licensed broker.  Please click here to schedule a call today!  Medicare Advantage Hospital


If you are eligible for Medicare Parts A & B, you are most likely eligible for Medicare Advantage.  Until recently, the only way you could be denied an advantage plan was end-stage renal disease (ESRD).  However, that will change as of 2021.  One thing to note, although Medicare Advantage does not require medical underwriting, some Medicare Supplement plans do.  So, it is imperative that you do your research to make sure that Medicare Advantage is, in fact, the plan for you.  Often people are initially attracted to Medicare Advantage Plans, but decide to switch further down the line.  If you decide to switch to a Medicare Supplement or Medigap plan later in life and you are no longer as healthy, you may be denied.  


Medicare Advantage Plans help to supplement the coverage provided by Medicare Parts A & B.  You can enroll in Medicare Advantage, also known as Medicare Part C, during your open enrollment period, which is the three months prior to, the month of and the three months after your 65th birthday.  This same open enrollment period applies to those who are eligible for Medicare Parts A & B through a disability.  Instead of your 65th birthday, you would qualify on your 25th month of receiving disability.  These months do not need to be continuous.

You may also qualify for a special enrollment period.  Perhaps, you are still working past 65 and have delayed medicare, and are receiving coverage through an employer.  The list for qualifying events for a special enrollment period for Medicare Part C is actually quite long, so if you miss your individual open enrollment period and hope to qualify for a special enrollment period, we recommend you contact a licensed broker for assistance.  If you do not enroll during either of these periods, you may enroll during the annual enrollment period (AEP).  The AEP runs from October 15th to December 7th.  Coverage would then begin on January 1st.  During this time you may:

  • Sign up for a Medicare Advantage Plan or Part D Prescription Plan
  • Switch Medicare Advantage Plans or Part D Prescription Plans
  • Leave a Medicare Advantage Plan or Part D Prescription Plan


With Medicare Advantage, you may choose an HMO or PPO.  There are general rules and criteria for each type of plan, but your carrier may have its own set of criteria. 


You’ve probably heard this term before.  Dependent upon the carrier you choose, you need to know the following about your HMO Plan:

  • You must use an in-network provider except for emergency care, out of area urgent care, and out of area dialysis
  • You will need a primary care physician
  • You will need a referral to see a specialist
  • If you receive out of network healthcare, you will be responsible for the full costs

In general, it is best to determine the rules for your specific plan before moving forward with any type of medical service.


You’ve probably heard of PPO’s as well. Generally speaking there is a little more flexibility with PPOs than HMOs.  With a PPO:

  • There are in-network and out of network providers.  If you see an in-network provider, you will pay less, but you will be covered either way
  • You do not need to select a primary care physician
  • You do not need a referral to see a specialist

Although PPOs have more flexibility, they tend to have higher out-of-pocket costs.

The most important in choosing a Medicare Advantage plan is to make certain that your doctors and hospitals accept your plan. If not, you will end up with large pockets costs!  Additionally, benefits can vary tremendously from carrier to carrier, so it is important to make sure you are covered by the right carrier.  


  • If you decide to enroll in a Medicare Advantage plan, make sure to present your Medicare Advantage Card when you receive services.  If you present your original Medicare card, your claim will eventually be denied and you will receive a bill!  Upon enrolling to Medicare Advantage, we advise our clients to put their Red, White, and Blue Medicare card in a safe place as they will not be using them while enrolled in a Medicare Advantage plan.
  • Benefits can change from year to year so discuss what is most important to you with your broker to ensure you are on the best plan for you!
  • Your copays can stack up at a single visit if there are multiple tests involved. 

As you can see, Medicare Advantage has its ups and downs, however, it may still be the plan for you.  For many, the price and added benefits are a driving reason to choose an Advantage plan.  However, as with anything, we advise you to do your research in advance to make sure you are getting the right plan for your needs.   You can learn more about Medicare Advantage here or call (888) 918-0518 to speak with a licensed broker.  Also, make sure to check out our youtube video below!

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Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.

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