Helping you obtain better coverage & lower costs


Medicare Advantage Plans – Are They For You?


Medicare Advantage or Part C plans have become popular in recent years.  In a Medicare Advantage plan, private insurance companies offer health plans that cover all of Part A and Part B benefits and may cover Part D prescription drug benefits.  These plans come in various forms and are often available for $0/ month or for low additional costs per month.  The majority of individuals on Original Medicare due to being on Social Security Disability and those on Original Medicare who have household income less than $1500/month will typically enjoy increased benefits at equal or lower costs to Original Medicare through a Medicare Advantage plan.

Major Benefits of Medicare Advantage Plans over Original Medicare

  • Out-of-pocket maximum limits on total enrollee cost sharing for Part A and B services (often under $5000 annually)
  • Lower costs through use of copays
    Most plans are $0 (in addition to Part B premium) or low cost (usually under $80 in addition to the Part B premium)
  • Many plans offer prescription drug coverage at no additional cost above the Part B premium
  • Lower Drug plan deductibles (often only on higher tier drugs)
  • Lower Drug Costs (especially if use insurance company pharmacy with 90 day supplies)

Common Additional Benefits with Medicare Advantage Plans

*Not all benefits are included in every plan

  • Routine vision care and glasses/contacts allowance
  • Routine dental care including cleanings, fillings, X-rays, and sometimes dentures
  • Routine hearing screenings and hearings aides
  • Over-the-counter quarterly drug allowance (Usually from $50-300/ quarter)
  • Silver Sneakers or comparable gym membership
  • 24/7 nurse line
    Online doctor portals
  • Travel assistance to medical appointments (typically 12-24 roundtrips annually)
  • Preventive health screening rewards (gift cards, etc.)
    Additional preventive health screenings
  • Chiropractic services (usually limited in type)
    In-home safety assessments
  • Annual physical exams (not simply annual wellness visit)
    Reduced costs on specific drugs
  • Optional additional comprehensive coverage for dental, vision, hearing
  • Significant additional benefits within SNP / Dual Coverage plans
  • A monthly allowance for healthy foods

Drawbacks of Medicare Advantage Plans

  • Very few in current top down medical provider environment
  • Must see doctors within network in HMOs
  • May not be able to see “nation’s best doctor” for specific medical problems
  • Must usually get referrals or prior approval for specialists or certain higher tier drugs in HMOs
  • Costs for out-of-network providers in PPOs can be higher
  • Because Medicare Advantage plans are geographic specific – some rural areas have fewer options and higher premiums

Our 4 Step Process is designed to customize a solution that fits your budget, your lifestyle, and your current situation. No matter where you’re at in life or what your current financial situation is, we can find a plan for you. 

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