Medicare
Medicare Advantage
Part C plans that bundle hospital, medical and usually drug coverage into one carrier network, often with dental, vision and fitness extras.
- Who it suits
- Individuals
- Carriers shopped
- The whole panel
- Cost to you
- $0
Overview
What this line actually does
A Medicare Advantage plan replaces the way Original Medicare pays your claims. You keep Medicare, but a private carrier administers your Part A and Part B benefits under a network, with its own copays, its own out-of-pocket maximum and usually Part D built in.
The trade is straightforward: lower predictable monthly cost and extra benefits, in exchange for a network and prior authorisation. That trade is a good deal for some people and a poor one for others, and which group you are in depends almost entirely on your doctors, your prescriptions and how much you travel.
Central Ohio is a strong Advantage market because the major hospital systems contract widely. That is not true everywhere, which matters if you spend winters out of state.
How it works
From first call to in force
Confirm eligibility
Part A and Part B active, and you live in the plan's service area.
List doctors and drugs
Bring the actual names and dosages. This is the step that decides the answer.
Compare plans
We narrow the field to the plans that cover your providers and your prescriptions.
Enroll in a window
Your Initial Enrollment Period, the Annual Election Period, or a Special Enrollment Period if one applies.
Review each fall
Formularies and networks change every year. So does your medication list.
What moves the number
Cost factors
| Factor | Why it matters |
|---|---|
| Network type | HMO plans require in-network care except emergencies. PPO plans allow out-of-network at a higher cost share. |
| Prescriptions | The same drug can sit on tier 2 with one carrier and tier 4 with another. Tier placement moves annual cost more than the premium does. |
| Travel | If you spend months out of the area each year, an Advantage network can become a problem that a Supplement does not have. |
| Out-of-pocket maximum | Every Advantage plan has one. It is the real protection the plan is selling. |
| Extra benefits | Dental and hearing allowances vary widely. Read the allowance amount, not the word 'included'. |
Scroll the table sideways to see every column.
Related lines
Often looked at alongside this
Before you decide
Medicare Advantage questions we hear most
If your question is not here, call the desk. Nobody will put you on a list for asking.
Only if that doctor is in the plan's network. We check every provider on your list against each plan before you enroll, and we tell you plainly when a plan does not work for you.
Many plans carry a zero-dollar plan premium, but you still pay your Part B premium to Medicare, plus copays and coinsurance when you use care. Zero premium is not zero cost.
You can change Advantage plans during the Annual Election Period each autumn, or the Medicare Advantage Open Enrollment Period in the first quarter. Moving to a Medicare Supplement later may require medical underwriting.
No. Carrier compensation for Medicare Advantage is set at a fixed amount by federal rule, so there is no financial reason for us to steer you.
Bring us the file. We will bring the market.
Send a census or ask one question. Either way it costs you nothing and nobody will chase you.
Independent and multi-carrier. $0 cost to work with us. No pressure scripts.