Medicare Advantage

Did you know that some Medicare plans offer fitness memberships, dental coverage, and vision benefits? We want to make sure you understand all the benefits that are available to you so you can get the most value for your money. This page will go more in-depth about Medicare Advantage.

The Basics of Medicare Advantage

Medicare Advantage plans, Part C of Medicare, are offered by private insurance companies like Cigna, Aetna, Humana, Anthem, United Healthcare, etc. who contract through Medicare as substitutes for Original Medicare. They may be referred to as “Medicare replacement” or “MA” plans. 

To qualify for a Medicare Advantage plan, you have to meet three criteria:

  1. Be enrolled in Medicare Parts A and B.
  2. Live in the plan’s service area, which is by county (some plans will be available in one county but not in another).
  3. Not have end-stage renal disease (ESRD).
Why Consider Medicare Advantage?

With a Medicare Advantage plan, you get the same or better benefits as Original Medicare. Many plans include prescription drug coverage (Part D). You can also shop for plans that may include additional benefits like wellness programs, dental and vision care, over-the-counter products, and more. 

Some Medicare Advantage plans offer a Medicare giveback benefit — a reduction on your Part B premium — because policyholders must continue to pay their Part B premiums while enrolled in Medicare Advantage. 

Medicare Advantage plans may offer extra benefits, like:

Another reason why so many beneficiaries enroll in Medicare Advantage is because they can often find a $0 premium plan in their area. To be clear, Medicare Advantage plans are not free, but they can give you MORE for your Medicare dollar. 

Types of Medicare Advantage Plans

There are many plans to choose from. No matter which plan you join, it will have an annual maximum out-of-pocket limit, which can vary by plan. This protection for your wallet is not something you get with Original Medicare alone. 

Hale Health Benefits can help you figure out which type of plan you should be on. 

What’s the Tradeoff?

The catch to getting access to additional benefits is that you agree to play the Medicare Advantage plan’s rules. For example, most plans have a network of doctors, hospitals, and other providers from which you can receive care. You typically cannot go outside of the network unless it’s an emergency. 

Some plans also have you pick a primary care physician (PCP) who will coordinate your care. Many require a referral from this PCP for you to see a specialist. 

If these restrictions might cause some trouble for you, you should look into Medicare Supplement Insurance — which you can use with any provider that accepts Medicare. 

Get a Quote
Compare Plans with a Licensed Expert

Since the benefits, copays, and max out of pocket differ from one plan to another, it’s best to shop for plans with the help of a local, licensed broker, like Hale Health Benefits. We represent Medicare Advantage programs and most companies that offer them in Idaho. And we don’t charge a fee for our services!

Important Note: Your plan premium and benefits can change each year. You can review your options during the Annual Enrollment Period from October 15 to December 7 (every year). 

Get the Most Out of Your Medicare Benefits.

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