What Exactly Are Medicare Advantage Plans and How Can They Benefit You

Medicare Advantage Plans

 Overview: Learn how Medicare Advantage Plans work and how you can find plans available in your area 

Medicare Advantage Plans are a type of plan offered by private insurers. It’s a bundled alternative to Original Medicare, whereby private insurers contract with the federal government to provide health insurance benefits to people who qualify.

>> READ MORE: Nerd Wallet – What Is a Medicare Advantage Plan?

These Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” that are offered by Medicare-approved private companies follow a set of rules.


  1. Medical Conditions. Medicare Advantage Special Needs Plans (SNPs) are geared to the needs of very specific populations, and can be a good choice for people with certain medical conditions, as well as those who are institutionalized or who are Medicare-Medicaid dual eligible.

  1. Disability. You can get a Medicare Advantage plan if you’re Medicare-eligible, even if you’re under 65 (as of 2021, even enrollees with ESRD can sign up for Medicare Advantage; this was not the case prior to 2021 unless the Advantage plan was an ESRD Special Needs Plan).

  1. Missed Enrollment. If you’re enrolled in only Original Medicare and your Medigap open enrollment window has already passed, a Medicare Advantage plan might make more sense, since there’s an annual open enrollment period for Medicare Advantage.

  1. Extra Benefits. Do you care about extra benefits like dental, vision, hearing aids, and gym memberships? These are often covered on Medicare Advantage plans, but not Medigap.

  1. Premiums. Here’s a big one: premium cost. In most areas, there are “zero-premium” Medicare Advantage plans available. According to the Kaiser Family Foundation, 98 percent of Medicare beneficiaries had access to at least one zero-premium Medicare Advantage plan in 2021.

>> READ MORE: How to Choose Between Medicare Advantage, Medigap and Part D

  1. Out-of-pocket Exposure. With most Medicare Advantage plans, keep in mind that you’ll pay coinsurance and copays, and the out-of-pocket maximum can be as high as $7,550 (for services that would be covered under Medicare Part A and B; Medicare Advantage enrollees will incur additional out-of-pocket costs for the prescription drug component of their coverage, since that’s not a benefit that would be covered by Medicare Parts A and B).

  1. Plans to Travel. If you plan to travel Medicare out of country, advantage plans can cover foreign travel beyond Original Medicare’s limited situations, but each Medicare Advantage plan is different so it’s imperative that you check the plan details before enrolling.

  1. Network Size. With Medicare Advantage, each plan has its own network, and you may be limited to a much more local or regional area.

  1. Plan Availability. Although most Medicare beneficiaries have access to a wide range of Medicare Advantage plans, the options vary considerably from one area to another. Keep in mind there are some areas of the country where no Medicare Advantage plans are available (mostly rural areas in the western part of the U.S., including the entire state of Alaska).

  2. Plan Change Flexibility. Medicare Advantage is a guaranteed issue for all enrollees during its initial enrollment periodthat lets enrollees switch plans.

  3. Having Medicaid or a Medicare Savings Program. Medicare covers many services, but it doesn’t cover long-term care benefits and can leave its enrollees with large cost-sharing expenses


Not all Medicare Advantage Plans work the same way. Before you join, take the time to find and compare Medicare health plans in your area. Once you understand the plan’s rules and costs, here’s how to join:

  • Use Medicare’s Plan Finder.

  • Visit the plan’s website to see if you can join online.

  • Fill out a paper enrollment form. Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.

  • Call the plan you want to join. Get your plan’s contact information.

  • Call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048

When you join a Medicare Advantage Plan, you’ll have to give these:

  • Your Medicare number

  • The date your Part A and/or Part B coverage started

This information is on your Medicare card. (Source)


Like most things in life, Medicare Advantage plans have benefits and drawbacks. We’ve already addressed a few previously, but let’s summarize what to look for:


  • Additional benefits, which may include some cost savings or subsidies toward hearing, dental and vision care.

  • Potentially lower premiums for coverage.

  • Limits on how much you may have to pay out-of-pocket for hospital and medical coverage. (Determined by the Centers for Medicare & Medicaid Services; is $7,550 in 2022.)


  • Less freedom to choose your medical providers.

  • Requirements that you reside and get your non-emergency medical care in the plan’s geographic service area.

  • Limits on your ability to switch back to Original Medicare with a Medicare Supplement Insurance policy.

  • The potential for the plan to end, either by the insurer or by the network and its included medical providers. (If this happens, you’ll be notified and offered other options.)


 >> A Guide To Covered California In 2022 

 >> How To Close Out Open Enrollment For Individual & Family Health Plans 

 >> The Penalty For Not Purchasing Health Insurance 

Your Healthcare Options Part 1

Healthcare Options

What Are Your Healthcare Options?

If you are over or close to the age of 65, Medicare is something that you might be utilizing or thinking about using. If you are in that boat, then it is essential to know your open enrollment times. If you are looking to go with the Medicare Advantage Plan, open enrollment is upon us.

Recipients of Medicare have a choice between the Medicare Advantage Plan or the Medicare Supplement Plan which is like a PPO plan. The difference between the two is that in the Advantage plan you will pick a primary care physician who will direct your care. They are known as the gatekeeper. If you need to see any specialist, they will provide a referral for that. Under a PPO contract, you have the flexibility to direct your care. You do not have a primary care physician, and you have a choice of any doctor in your provider network. This option does have a higher cost in comparison to the Medicare Advantage Plan so we often see people in this area choose the Advantage Plan and it works well for them. Many doctors prefer this plan over the PPO option, as well, because there are Medicare Reporting standards that they are held to and it is easier to capture that data on this particular plan.

The Medicare Advantage plans and Part D have open enrollment starting on October 15 and ending on December 7. So if someone has original Medicare and purchases a drug plan without any other supplemental coverage that is the time that they can change their drug plan because Medicare by itself does not cover medication.

At Bernardini & Donovan, we work very closely with a majority of our clients who utilize the Medicare Advantage Plan. If that is something that you know that you want to look into, there is no one better for you talk to than us. Our years of experience allow us to help you plan and see how you can have the low cost of the Advantage Plan while having the best possible health care available to you. Please feel free to call us today to set up an appointment if you have questions.

Costs & Benefits of Medicare Advantage Plans

When considering Medicare Advantage Plans, it helps to take a closer look at their benefits and costs so that you can more easily understand the plans.

As you may know, these plans contract annually with Medicare and a fixed monthly amount gets paid by Medicare. That amount can change yearly, based on Medicare, and varies by county. 

The nice thing about these plans is that they sometimes offer coverage for things that Medicare does not cover. This can include things like eye exams, prescription coverage and dental visits, but it does vary by county.

You should know that there is a monthly premium for these plans and it is in addition to the Medicare Part B premium. 

While some services under these plans require co-payment, they are often at a lower amount than the Medicare fees. And legally the amount is not allowed to exceed the Medicare fee amount.

If you want more information on Medicare Advantage Plans, then contact Bernardini & Donovan Insurance Services today.

What Types of Medicare Advantage Plans are Available?

Medicare Advantage plans are alternatives to traditional fee-for-service Medicare. The plans are sponsored by the federal Medicare program, which pays private health insurance companies to administer and provide coverage to those eligible for Medicare. In other words, Medicare coverage is provided by an insurance company like Humana or United Healthcare rather than directly from the Centers for Medicare and Medicaid Services.

There are several types of Medicare Advantage plans from which to choose:

1. Health Maintenance Organizations or HMOs.

These plans require beneficiaries to select a primary care doctor who manages all healthcare needs. Services from specialists require a referral from the primary care doctor before the plan will pay benefits.

2. Preferred Provider Organizations or PPOs.

These plans include a number of in-network providers who charge a lower co-payment than providers outside the network.

3. Private Fee-for-Service Plans or PFFSs

These plans allow beneficiaries to go to any Medicare-approved doctor or facility, as long as the specific plan is accepted by the provider.

4. Special Needs Plans or SNPs.

These plans are for people with people with certain health conditions or who are living in a nursing home.

To learn more about the Medicare Advantage plans that are available to California residents, please contact Bernardini & Donovan Insurance Services. 

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