Medicare Advantage Plans: An Alternative to Original Medicare

• by Christian Worstell
• September 5, 2023
• Reviewed by John Krahnert

If you aren’t entirely satisfied with Original Medicare coverage (Medicare Part A and Part B), or  want to find out how to get additional benefits that aren’t offered by Original Medicare, there are alternative options you can consider.

One popular option you might consider are Medicare Advantage plans. In fact, more than 22 million Medicare beneficiaries were enrolled in Medicare Advantage plans in 2020, which is more than one third of all Medicare beneficiaries.¹

What is a Medicare Advantage plan?

Medicare Advantage plans (also called Medicare Part C) are sold by private insurance companies in many areas throughout the country the country.

There were over 3,148 different Medicare Advantage plans available throughout the country in 2020, although the selection of plans will vary from one location to the next.¹

What do Medicare Advantage plans cover?

Medicare Advantage plans are required by law to provide the same hospital insurance and medical insurance coverage as Original Medicare, combined under one plan.

Some Medicare Advantage plans may offer additional benefits, which can include:

• Prescription drug coverage
• Dental care
• Hearing care
• Vision care
• Membership to SilverSneakers or other wellness programs

The list of additional benefits that can be offered by Medicare Advantage plans has grown to include items such as bathroom grab bars, healthy food options and services such as transportation to doctor’s appointments.

Not all of these benefits are offered by every Medicare Advantage plan, and not all plans are available in every location.

Medicare Advantage vs Medigap plans

Medicare Advantage plans and Medicare Supplement (Medigap) are two different types of Medicare coverage that are quite different. You cannot have a Medicare Advantage plan and a Medicare Supplement plan at the same time.

Medigap is a type of private Medicare insurance. These plans provide coverage for some of Original Medicare’s out-of-pocket costs such as deductibles, copayments and coinsurance. 

While Medicare Advantage plans are used in place of Original Medicare, Medigap plans are used on top of Original Medicare as a form of supplemental coverage.

And while Medicare Advantage plans provide coverage for services and items, Medigap plans typically provide coverage only for these out-of-pocket Medicare costs. 

Do Medicare Advantage plans cover Part D?

Medicare Part D is another type of private Medicare coverage. These plans provide coverage exclusively for prescription medications. They are used alongside Original Medicare, which does not cover prescription drugs in most cases. 

Many Medicare Advantage plans include Part D coverage. These are called Medicare Advantage Prescription Drug plans, or MAPD plans. 

What types of Medicare Advantage plans are available?

There are a few different types of Medicare Advantage plans. Not every plan is guaranteed to be available in every area.

Types of Medicare Advantage plans include:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Special Needs Plans (SNP)
• Private Fee-For-Service (PFFS)
• Medical Savings Accounts (MSA) 

How much do Medicare Advantage plans cost?

Because Medicare Advantage plans are sold by private insurance companies, the cost of plans can vary from one company or state to another.

The average premium for a Medicare Advantage plan in 2022 is $62.66 per month.²

Some Medicare Advantage plans may even feature $0 premiums, though $0 premium plans may not be available in all locations.

Who is eligible for Medicare Part C?

There are only two basic requirements to gain eligibility for most Medicare Advantage plans:

1. Be enrolled in Part A and B of Medicare
2. Not have End-Stage Renal Disease (although there are some Special Needs Plans that you may be eligible for if you have ESRD)

When can you enroll?

There are a few different opportunities to enroll in a Medicare Advantage plan. The first is during your Medicare Initial Enrollment Period.

If you miss your Initial Enrollment Period, you can also sign up for a Medicare Advantage plan (or switch from your current Medicare Advantage plan) during the Medicare Open Enrollment Period. This period, also called the Medicare Annual Election Period, happens every year from October 15 through December 7.

You may also be able to sign up for a plan at another time if you happen to qualify for a Medicare Special Enrollment Period (SEP). A Medicare SEP can take place at any time throughout the year based on certain criteria.

How do you sign up for Medicare Advantage?

A licensed insurance agent can help you go over the Medicare alternative plan options that are available in your area and detail the costs, coverage and terms of each plan.

You can compare any Medicare Advantage plans that are available in your area, which could include plans from a number of providers.

Call today to speak with a licensed agent, or request a free plan comparison online.

¹ Jacobson, Gretchen, et al. (Oct. 24, 2019) Medicare Advantage 2020 Spotlight: First Look. Kaiser Family Foundation. Retrieved from https://www.kff.org/report-section/medicare-advantage-2020-spotlight-first-look-data-note.

² MedicareAdvantage.com’s The Average Cost of Medicare in 2022 report. Nov. 16, 2021.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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