Medicare Advantage Made Easier to Understand
Medicare Advantage plans can offer another way to receive your Medicare benefits, often combining medical coverage and prescription drug coverage in one plan. Understanding your options can help you make a confident decision about your coverage.
What Is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is another way to receive your Medicare benefits through a private insurance plan approved by Medicare.
A Different Way to Receive Medicare
Medicare Advantage plans are offered by private insurance companies that contract with Medicare. These plans provide Medicare-covered Part A and Part B services through the plan. Many Medicare Advantage plans also include prescription drug coverage.
Depending on the plan, you may have access to:
Why Consider Medicare Advantage?
Depending on the plan, Medicare Advantage may offer coverage and additional benefits that can make it an attractive option for some Medicare beneficiaries.
Cost Considerations
Some Medicare Advantage plans may have low or $0 monthly premiums. Plans can also have copays, deductibles, and other out-of-pocket costs.
Prescription Coverage
Many Medicare Advantage plans include prescription drug coverage, allowing eligible members to receive medical and prescription benefits through one plan.
Extra Benefits
Depending on the plan, additional benefits may include dental, vision, hearing, fitness, over-the-counter items, and other supplemental benefits.
A Yearly Out-of-Pocket Maximum
Medicare Advantage plans have a yearly limit on what you pay out of pocket for covered Medicare services. The amount varies by plan.
Some plans may offer even more.
Depending on the plan and your eligibility, benefits such as OTC allowances, food or grocery benefits, and Part B premium giveback benefits may be available. We can help you understand what is available in your area.
Benefits, costs, eligibility, and availability vary by plan, insurance carrier, service area, and individual circumstances. Not all plans offer the benefits described above.
What Does Medicare Advantage Cost?
Medicare Advantage costs can look different from plan to plan. Understanding the main types of costs can help you compare your options more confidently.
Monthly Premium
Some Medicare Advantage plans may have a $0 monthly plan premium, while others charge a monthly premium.
Deductibles
A deductible is the amount you may need to pay before the plan begins paying for certain covered services.
Copays & Coinsurance
You may pay a set copayment or a percentage of the cost when you receive certain covered healthcare services.
Out-of-Pocket Costs
Plans have a yearly limit on what you pay out of pocket for covered Medicare services. The limit varies by plan.
One important number to know
Medicare Advantage plans have a yearly maximum on your out-of-pocket costs for covered Medicare services. Once you reach the plan's limit, you generally pay nothing for covered Medicare services for the rest of the year.
More Than Medical Coverage
Depending on the plan and your eligibility, Medicare Advantage may include additional benefits designed to support different healthcare and everyday needs.
Dental
Some plans may include dental benefits beyond what Original Medicare generally covers.
Vision
Depending on the plan, vision benefits may help with covered exams, eyewear, or other services.
Hearing
Certain plans may offer hearing-related benefits, including coverage or allowances for eligible services.
OTC Benefits
Some plans may provide an allowance for eligible over-the-counter health and wellness items.
Food & Grocery Benefits
Certain plans may offer food or grocery benefits for members who meet specific eligibility requirements.
Part B Giveback
Some Medicare Advantage plans may offer a Part B premium reduction for eligible members. Availability and amounts vary by plan.
Which benefits could be available to you?
Plan benefits and eligibility can vary. We can help you review the Medicare Advantage options available in your area.
Benefits vary by plan, carrier, service area, and individual eligibility. Not all plans offer every benefit shown.
Medicare Advantage vs. Original Medicare
Both options can provide Medicare coverage, but they work differently. Here's a simple overview of some key differences.
Original Medicare
Parts A & B
Medicare Advantage
Part C
Which option makes sense for you?
Your doctors, prescriptions, budget, healthcare needs, and preferences all matter. We can help you compare the options available in your area.
This comparison is a general overview and does not describe every Medicare Advantage plan or Original Medicare option. Coverage, costs, networks, and benefits vary.
Which Medicare Advantage Plan May Be Right for You?
There isn't one Medicare Advantage plan that's right for everyone. The best option depends on your doctors, prescriptions, healthcare needs, budget, and the plans available in your area.
HMO Plans
Health Maintenance Organization plans generally use a network of doctors and hospitals. Staying within the plan's network is typically important for receiving covered care.
- Network-based coverage
- May have lower out-of-pocket costs
- Primary care coordination may be important
PPO Plans
Preferred Provider Organization plans generally offer more flexibility when choosing providers. You may be able to receive care from out-of-network providers, although your costs may be higher.
- More provider flexibility
- May include out-of-network coverage
- Costs can differ between in-network and out-of-network care
Your Doctors & Hospitals
If you already have doctors you want to keep, checking the plan's provider network is an important part of comparing Medicare Advantage options.
- Doctors
- Specialists
- Hospitals and facilities
Your Prescriptions
Prescription coverage can vary between plans. Your medications, dosage, pharmacy preferences, and the plan's formulary can all be important when comparing options.
- Current medications
- Preferred pharmacies
- Plan formulary
Your Budget
Looking only at the monthly premium doesn't tell the whole story. Copays, deductibles, coinsurance, and the yearly out-of-pocket maximum can all affect your overall costs.
- Monthly premium
- Copays and deductibles
- Yearly out-of-pocket maximum
Benefits That Matter to You
Different plans may offer different additional benefits. We can help you look beyond the headline benefits and understand what is actually available with the plans you qualify for.
- Dental, vision & hearing
- OTC benefits
- Other plan-specific benefits
Let's Compare Your Options Together.
We work with multiple insurance carriers and can help you compare Medicare Advantage options available in your area based on your individual needs and eligibility.
Medicare Advantage plan availability, benefits, costs, provider networks, prescription coverage, and eligibility vary by plan, carrier, service area, and individual circumstances. We do not represent every plan available in your area.
Medicare Doesn't Have to Be Complicated.
We make the process easier by helping you understand your options, compare available plans, and make a decision you're comfortable with.
Understand
We start by explaining how Medicare Advantage works and what you should know before comparing plans.
Compare
We review available Medicare Advantage options based on your doctors, prescriptions, healthcare needs, and budget.
Choose
Once you understand the differences, we help you identify the option that best fits your individual situation.
Enroll
If you decide to move forward, we guide you through the enrollment process and help make sure the necessary steps are completed.
Stay Supported
Our relationship doesn't end when you enroll. We're here to help you understand your coverage and review your options as your needs change.
You Don't Have to Figure It Out Alone.
Medicare decisions can involve networks, prescriptions, costs, benefits, and enrollment rules. We take the time to understand what matters to you before helping you compare available options.
Medicare Advantage Enrollment Timeline
When you can enroll in or change a Medicare Advantage plan depends on your situation. Understanding the different enrollment periods can help you know when it's time to review your options.
Initial Enrollment Period
If you're becoming eligible for Medicare around age 65, your Initial Enrollment Period gives you a window to enroll in Medicare and choose your coverage.
Annual Enrollment Period
The Annual Enrollment Period is a time each year when Medicare beneficiaries can review their coverage and make certain changes for the following year.
Medicare Advantage Open Enrollment
If you're already enrolled in a Medicare Advantage plan, you may have an opportunity during this period to make certain changes to your coverage.
Special Enrollment Periods
Certain life events or changes in circumstances may give you a Special Enrollment Period. The rules and available options depend on the qualifying event.
Let's Figure Out Your Next Step.
Tell us where you are in your Medicare journey and we'll help you understand what options may be available based on your situation.
Enrollment periods and eligibility rules can vary based on individual circumstances. This information is intended as a general educational overview and is not a complete description of all Medicare enrollment rules. Please contact Medicare or a licensed insurance agent for guidance specific to your situation.
Medicare Advantage Options From Multiple Carriers
Medicare Advantage plans can vary significantly from one insurance company to another. We work with multiple carriers so you can compare available options instead of looking at just one company.
Blue Cross Blue Shield
The Best Option Isn't Always the Same for Everyone.
One plan may work well for one person but not another. Provider networks, prescriptions, costs, additional benefits, and plan availability can all be different.
That's why we look at your individual situation first and then help you compare the Medicare Advantage options available to you.
Review options from multiple insurance carriers.
Look at provider networks and healthcare facilities.
Consider medications, formularies, and pharmacy options.
Compare premiums, copays, deductibles, and out-of-pocket limits.
Coverage Across More Than 40 States
We help individuals explore Medicare options in more than 40 states. Plan availability and eligibility vary by location.
Ready to Compare Your Medicare Advantage Options?
Let's look at what's available in your area and find out which options may fit your needs.
Next Step Health Partners is not affiliated with or endorsed by the insurance carriers displayed above. Carrier names and logos are shown for informational purposes. Availability of plans, benefits, costs, networks, and eligibility varies by carrier, plan, service area, and individual circumstances. We do not represent every plan available in every area.
Ready to Explore Your Medicare Advantage Options?
Medicare Advantage plans can vary based on where you live, your doctors, prescriptions, healthcare needs, budget, and the benefits available to you. You don't have to sort through everything on your own.
We can help you understand your options, compare available Medicare Advantage plans from multiple insurance carriers, and take the next step with confidence.
