Medicare Advantage Plans

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Medicare Advantage Plans

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Medicare Advantage Plans are senior health insurance programs for adults age 65+. While many insurers offer Medicare Advantage plans, they are all closely monitored by the federal government. They are sure to be equal to, or better than traditional Medicare.

Medicare Advantage plans (sometimes called Medicare Part C, or MA Plans) provide all the same basic coverages as traditional Medicare, plus a touch more.
Additional perks of Medicare Advantage include drug coverage, senior cooking classes, and senior fitness programs like the Silver Sneakers program.

How Do Medicare Advantage Plans Work?

Medicare Advantage Plans have yearly contracts with Medicare. If you join a Medicare Advantage Plan, you’ll have all of the same rights and protections that you would have under Original Medicare, plus more.

Original Medicare v. Medicare Advantage Plans

Original Medicare		Medicare Advantage Plans
Part A Hospital Insurance	X	Part A Hospital Insurance	X
Part B Senior Health Insurance	X	Part B Senior Health Insurance	X
Part D Prescription Drug Coverage		Part D Prescription Drug Coverage	X
Vision Care and Glasses		Vision Care and Glasses	X
Hearing Care and Hearing Aids		Hearing Care and Hearing Aids	X

Also, depending on the Medicare Advantage Plan you select, you may have access to other programs like senior fitness classes and cooking classes.

Medicare Advantage Plans Benefits

Medicare Advantage plans are sometimes called “Part C.” Think of them as a bundle of parts A, B and D, and more.

In addition to the prescription drug coverage (Part D) – which can be incredibly valuable for seniors who require many prescriptions – Medicare Advantage plans often cover vision care & glasses, hearing aids and dental insurance. Some individuals can save thousands of dollars with a Medicare Advantage plan.

Additional Medicare Advantage Plans Coverage Benefits

Optometry, Vision Care, Glasses or Contact Lenses

Hearing Care, Hearing Aids

Diabetic Testing Supplies and Additional Care Items

Hardware – Like Shower Grab Bars and Wheelchair Ramps

Prescription Drugs

Depending on the Medicare Advantage plan you select, it might include lower out-of-pocket costs, which translates to lower co-pays, coinsurance and deductibles.

Medicare / Medicare Advantage Plans Eligibility

To enroll in Medicare or a Medicare Advantage Plan, you must be 65 (or about to be.)

Most working adults will qualify for Original Medicare or a Medicare Advantage Plan. If you were born in 1929 or later, you’ll need to pay into the program for 40 quarters (roughly ten years) in the 20 years before your retirement.

Employed Americans pay into the Medicare program every time an employer withholds payroll taxes.
Self-employed individuals pay a “self-employment tax” every time they file income taxes, which also counts towards eligibility.
Homemakers, or other individuals who didn’t work outside the home, may qualify for Medicare or Medicare Advantage based on their spouse’s employment history.
Even if you have never worked, you may still be able to purchase a Medicare Advantage plan.

Medicare / Medicare Advantage Enrollment Periods

Standard Enrollment Period

There is a seven-month enrollment period for Medicare, surrounding your 65th birthday.

Your Medicare Advantage / Original Medicare Enrollment Period begins three months before your birth, includes your birth month, and continues for three more months.

If you were born on April 15, your enrollment period would begin on January 1. It would include the month of April, and three more months – May, June and July.

If you don’t enroll on time, you might be subject to penalties, in the form of higher premiums, unless you qualify for a Special Enrollment Period (also called SEP.)

Special Enrollment Period (SEP)

If you haven’t retired at age 65 and continue to work full-time and enjoy an employer-sponsored group health insurance plan, you don’t need to switch to Medicare until you’re ready.

This is known as “creditable coverage.”
As long as the health insurance plan you have at work is equal to or better than Medicare, you can continue with that plan without incurring penalties.

When you retire, or when your employer stops providing health insurance, you will be eligible for Medicare at your standard rate. This is known as a Special Enrollment Period.

There are a few other situations that can trigger SEP. For instance, if you’re 66, but your spouse is 64 and providing your health insurance through their employer, you will be able to enroll when your spouse stops providing that coverage due to their retirement.

Other Enrollment Periods

In addition to your standard enrollment period and SEPs, you can enroll or make changes to your Medicare Advantage plan during other parts of the year.

The General Enrollment Period – January 1 – March 31 every year. If you have Part A coverage and get Part B for the first time during the General Enrollment Period, you can join a Medicare Advantage Plan. Simply know that coverage doesn’t start until July 1.

The Open Enrollment Period – October 15 – December 7. Anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1 of the upcoming year, as long as the plan receives your request by December 7.

A Word About Shopping For Healthcare

Health insurance is a very personal coverage. Since it relates to the specific issues and coverage needed by a given family or individual, it has a detailed health application. As you progress through this site, we will offer a number of solutions to your health care needs. When you have decided on one or maybe two offerings to pursue, you will be transported to that company’s website to complete the application. Keep the following in mind:

Privacy: EINSURANCE.com collects no personal data from you so we remain unbiased in the presentation of possible products. Make sure you pick a partner of ours with good credentials.
Registrations: If you register with us, we are able to keep track of your partner selections to assist you if need be in the future.
Detailed information: In most cases you will receive a phone call or an email to confirm or clarify your shopping process. If you receive too many phone calls or emails, please let us know immediately. Sometimes insurance organization get overzealous in their desire to help.

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Frequently Asked Questions (FAQs)

Get clear answers to common insurance questions and important details to guide your coverage decisions.

What are Medicare Advantage (Part C) plans and how do they differ from Original Medicare?

Medicare Advantage plans, or Part C, are private plans that combine Medicare Part A and B, and often Part D. They may also include extras like dental, vision, and wellness programs.

Who is eligible to enroll in a Medicare Advantage plan?

To qualify, you must be enrolled in Medicare Part A and B and reside in the plan’s service area.

When can I join, switch, or leave a Medicare Advantage plan?

You can enroll during the Annual Election Period (Oct 15 – Dec 7), Medicare Advantage Open Enrollment (Jan 1 – Mar 31), or a Special Enrollment Period triggered by life events.

What should I check regarding provider networks and coverage before selecting an MA plan?

You should confirm if your current doctors and hospitals are in-network. Out-of-network services may cost more or not be covered at all.

How do costs and benefits in MA plans compare to Original Medicare?

While premiums can be low or even $0, you must consider copays, deductibles, drug coverage, annual max out-of-pocket, and additional benefits.

What are the extra benefits in Medicare Advantage plans and do they vary?

Plans may offer extras like vision, dental, hearing aids, transportation, and gym memberships, but availability varies by plan and location.

What risks or pitfalls should I watch out for when choosing a Medicare Advantage plan?

Look out for small provider networks, plan benefit changes, high out-of-pocket costs, and marketing that oversells $0 premiums.

How does prescription drug coverage work with a Medicare Advantage plan?

Most MA plans include Part D, but check the drug formulary to ensure your medications are covered and review cost-sharing.

What happens if I miss the enrollment window or want to switch from Original Medicare to MA mid-year?

Outside enrollment windows, you may need to wait unless you qualify for a SEP. Already enrolled members can switch during MA Open Enrollment.

How do I apply for an MA plan via EINSURANCE and how do claims and service work?

Use EINSURANCE to compare MA plans by entering your ZIP code and health info. Once enrolled, the insurance provider—not EINSURANCE—handles claims and support.