Medicare Advantage: Everything to Know

For millions of Americans, Medicare Advantage plans offer an attractive alternative to Original Medicare. With added benefits, simplified coverage, and increasingly popular features, Medicare Advantage, also known as Part C, continues to gain traction. In fact, more than half of all Medicare-eligible individuals are now enrolled in a Medicare Advantage plan, and that number is expected to grow.

Whether you're new to Medicare or considering a change, understanding your options is essential. In this guide, we’ll break down what Medicare Advantage is, how it works, and how Unified Health can help you find the right plan.

What Is Medicare Advantage?

Medicare Advantage is a type of Medicare health plan offered by private insurance companies that are approved by Medicare. Also called Part C, these plans bundle the coverage you’d typically receive under Original Medicare Parts A and B, and often include additional benefits like vision and dental coverage.

When you enroll in a Medicare Advantage plan, your coverage is administered by a private insurer rather than directly by the federal government. However, you still remain part of the broader Medicare program.

What’s Covered Under a Medicare Advantage Plan?

Medicare Advantage plans are designed to be all-in-one solutions that streamline and enhance healthcare coverage. Here’s what’s typically included:

• Hospital insurance (Part A) – Typically covers inpatient care in hospitals and skilled nursing facilities.

• Medical insurance (Part B) – Usually covers outpatient care, doctor visits, and preventive services.

• Prescription drug coverage (Part D) – Most MA plans include drug coverage, so you don’t need a separate Part D plan.

• Additional benefits – Many plans offer services that Original Medicare doesn’t cover, such as:

  • Vision and hearing care

  • Dental coverage

  • Gym memberships and wellness programs

  • Over-the-counter allowances

It’s important to note that exact coverage varies based on the plan and your geographic location. Working with licensed agents can help the process of knowing what's available to you easier to understand.

How Medicare Advantage Plans Work

So, how does Medicare Advantage work? In short, Medicare pays a set amount to private insurers to manage your care, and the insurers take on the responsibility of providing your benefits. You still have Medicare rights and protections, but your plan may have different rules for things like provider networks, referrals, and costs.

Here’s how it breaks down:

• Plan types: Most MA plans are either HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations), meaning your access to care may be limited to a specific network of doctors and hospitals.

• Costs: While some plans typically have a $0 premium, others require a monthly payment in addition to your Part B premium. You’ll usually also encounter:

  • Co-pays for doctor visits and services

  • Possible deductibles

  • Coinsurance amounts

• Out-of-pocket maximums: Unlike Original Medicare, MA plans have a yearly limit on your out-of-pocket costs. Once you reach that limit, the plan usually covers 100% of covered services for the rest of the year, providing important financial protection.

If you’re wondering “how does Medicare Advantage work” in real-world terms, think of it as a prepaid health plan. You pay your share, and the insurer coordinates your care under a defined set of rules.

Types of Medicare Advantage Plans

There are several types of Medicare Advantage plans to choose from, depending on your health needs and preferences:

Plan Type	Primary Doctor	Specialist Referrals	Out-of-Network Care	Drug Coverage	Costs
HMO	Required	Usually Required	Limited	Often Included	Lower
PPO	Not Required	Not Required	More Flexibility	Often Included	Higher
PFFS	Not Required	Not Required	Varies by Plan	Sometimes	Varies
SNP	Required	Often Required	Limited	Included	Tailored

Working with a licensed agent can help you compare these options and determine which type of plan is the best fit based on your lifestyle, health conditions, and provider preferences.

Pros and Cons of Medicare Advantage

Like any healthcare decision, choosing a Medicare Advantage plan comes with benefits and trade-offs. Here's a breakdown:

Pros of Medicare Advantage

• Extra benefits beyond original Medicare

• All-in-one coverage for simplicity 

Cons of Medicare Advantage

• Limited provider networks

• May require referrals to specialists

• Costs/coverage vary by plan and location

The decision ultimately depends on what you value most, whether that’s lower upfront costs, access to specific doctors, or comprehensive benefits. Licensed agents, like the ones you work with at Unified Health, can help individuals weigh these pros and cons when selecting a plan.

How to Enroll in a Medicare Advantage Plan

Enrolling in a Medicare Advantage plan is relatively straightforward, but timing and eligibility are key. Here’s what you need to know:

Eligibility Criteria:

• Must be enrolled in both Medicare Part A and Part B

• Must live in the plan’s service area

• Must not have End-Stage Renal Disease (ESRD), with some exceptions

Enrollment Periods:

• Initial Enrollment Period (IEP): 3 months before to 3 months after your 65th birthday

• Annual Enrollment Period (AEP): October 15 – December 7, for coverage starting January 1

• Medicare Advantage Open Enrollment: January 1 – March 31, allows you to switch MA plans or return to Original Medicare

Working with licensed agents helps provide free support during all of these periods, helping you compare plans, avoid common enrollment mistakes, and make a confident decision.

Making the Most of Your Medicare Options

Medicare Advantage offers a flexible, often cost-effective way to receive your Medicare benefits, all under one plan. With coverage that goes beyond Original Medicare, including drug coverage and extra perks, it’s easy to see why enrollment is on the rise.

Still, choosing the right plan can feel overwhelming. That’s where Unified Health comes in. Our team of licensed professionals is here to help you understand your options and enroll in a Medicare Advantage plan that’s tailored to your health, lifestyle, and budget.

Ready to explore your options? Contact Unified Health today for personalized guidance.

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