What is a Medicare Advantage Plan (And Do I Need One?)

When it comes to Medicare, you have a lot of choices and one of the most common is a Medicare Advantage Plan. These plans are an alternative to Original Medicare and often come with added benefits. If you're wondering what these plans are, how they work, and whether one might be right for you, this blog will help break it down.

What Is a Medicare Advantage Plan?

A Medicare Advantage Plan offers coverage through a private company instead of through government-provided Medicare. One way to receive your Medicare Coverage is by enrolling in a Medicare Advantage Plan (like an HMO or PPO). Medicare Advantage Plans, sometimes called “Part C” or “MA Plans” are offered by private insurance companies approved by Medicare.

It’s important to remember Medicare Advantage Plans are not Medicare Supplements. These plans will provide coverage for your approved Medicare Part A (hospital) and Part B (medical) coverage.

Many of the Medicare Advantage plans will have a network of contracted providers and facilities. It’s important to understand how the network functions and to be sure the plan you choose contracts with the providers you want to use.

Medicare Advantage vs Medicare Supplements: Which One Is Right For Me?

Do I Need a Medicare Advantage Plan?

The answer to that question is: it depends on your needs. The reason why some people choose a Medicare Advantage Plan is because the coverage offered under Medicare is not sufficient for their needs. If you have a chronic condition, frequently visit the doctor, need prescription drug coverage or just require more care that Medicare accounts for, this can be an attractive option.

Some people choose a Medicare Advantage Plan because, for them, that plan is more affordable than signing up for Medicare and then a supplement plan to fill in gaps. Deciding if you want a Medicare Advantage Plan is best decided through careful thought and a conversation with a dedicated agent.

What Do Medicare Advantage Plans Cover?

Medicare Advantage Plans (MAPDs) must cover everything that Original Medicare (Parts A and B) covers and more. One major difference: MAPDs include a maximum out-of-pocket (MOOP) limit, while Original Medicare does not.

In addition to standard Medicare benefits, MAPDs typically offer:

• Prescription drug coverage (Part D) included in most plans
• Dental coverage for cleanings, exams, and sometimes more extensive procedures
• Vision benefits, including routine eye exams and eyewear allowances
• Hearing coverage, such as hearing exams and hearing aid discounts or allowances
• Wellness benefits, like gym memberships, fitness classes, or health coaching
• Emergency and urgent care coverage outside your plan’s service area (within the U.S.)

These extra benefits can vary by plan, so it’s important to compare Medicare plan options based on your needs.

8 Questions to Ask When Enrolling in a Medicare Advantage Plan

Who Can Join a Medicare Advantage Plan?

To join an Advantage Plan, you must be enrolled in Medicare Parts A and B. Some of the plans may have a monthly premium in addition to your Medicare Part B premiums, which you must continue to pay. You must live within the plan’s service area. Plan benefits can change from year to year (annual renewable).

When Can I Enroll in a Medicare Advantage Plan?

There are generally only certain times of the year when you can join a Medicare Advantage Plan. Let’s break down the different enrollment periods so you can understand when the right time is for you to sign up or make changes to your Medicare Advantage Plan:

Initial Enrollment Period (IEP): The first time you can sign up for a Medicare Advantage Plan is during your IEP, which begins three months before you turn 65 and lasts for seven months.

Annual Enrollment Period (AEP): AEP runs from October 15–December 7 each year. During this time, you can compare your options and make changes to your plan if needed.

Medicare Advantage Open Enrollment Period: If you’re already enrolled in a Medicare Advantage Plan, this is your chance to make changes between January 1–March 31. You can switch plans or return to Original Medicare.

Special Enrollment Periods (SEPs): There are also special times when you can enroll or make changes to your plan due to certain circumstances, like moving or qualifying for additional coverage.

Medicare Guidance You Can Count On

When it comes to choosing the right Medicare coverage for your needs, the guidance of an experienced insurance professional can make all the difference. For over 50 years, the team at Twin City Underwriters has helped guide individuals through their Medicare choices; we take the time to understand your specific health needs and lifestyle. Our team offers personalized guidance designed around your situation, giving you the confidence and clarity to make decisions that work best for you.

Reach out to us today, and we'll gladly support you through your Medicare options with expertise and care.

This is an updated blog that was originally published in 2021. 

Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!

Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, UCare, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.