More than 44 million Americans are Medicare recipients, and more than 22 million receive their benefits through a Medicare Advantage plan. A Medicare Advantage plan is Medicare. However, it offers you expanded coverage options that are not available from the benefits provided by Original Medicare.
If you qualify for Medicare Advantage, you will be able to access covered care services that you might not be able to afford otherwise. These quality plan options come in many shapes and sizes and are offered by multiple private insurers throughout the nation.
Bourgeois Insurance strives to offer all Medicare recipients access to efficient, customer-focused plan services. For help choosing the Medicare Advantage option that is best for you, just give us a call at
The U.S. government’s primary Medicare program is called Original Medicare, and it includes two types of benefits called Part A & Part B coverage. Part A coverage supplies hospital benefits, while Part B pays for outpatient and other care related to your everyday health needs.
However, Original Medicare will not include certain benefits, such as dental, vision, hearing or prescription drug coverage. To get these expanded benefits, you might qualify to enroll in a Medicare Advantage plan. Medicare Advantage plans (also known as Medicare Part C) are private insurance plans that will offer you all the perks of Original Medicare, but with added coverage.
Even though Medicare Advantage plans come from private insurance companies, you are still a part of the Medicare program. Therefore, Medicare Advantage plans always contain nearly all the benefits of Original Medicare Parts A & B and must meet coverage standards set by law. You just receive your benefits from a different source.
However, Advantage plans offer further benefits such as:
Prescription Drug Coverage
Other benefits might also be included in your plan. Therefore, by buying a Medicare Advantage plan, you will have coverage for a greater diversity of your health care needs.
There are many Medicare Advantage plan options available, including:
HMOs (Health Maintenance Organizations)
Under an HMO plan, you must receive care within your plan’s coverage network unless you have to receive emergency care or urgent care services. To receive specialist care, you usually must receive a referral from your primary care provider. Certain plans, called HMO Point-of-Service plans (HMOPOS) allow you to receive out-of-network care for a higher out of pocket cost.
PPOs (Preferred Provider Organizations)
Under a PPO plan, you will pay the lowest price for your care if you see a doctor within your plan’s network. While you can go outside of the network for certain care, you will not receive the full coverage you will have otherwise.
PFFS (Private Fee-for-Service Plans)
PFFS plan networks do not function like the networks of HMO or PPO plans. If you see a provider outside your network, then that provider must agree to accept the payment terms of your policy before they will provide you with care. Out-of-network care might cost more than in-network care.
Special Needs Plans (SNPs)
These plans are designed to cover individuals with certain chronic health conditions who might need extra health benefits. Though these plans include the same coverage as every Medicare Advantage plan, they can also offer special expanded benefits depending on the policyholder’s conditions.
MSAs (Medical Savings Accounts)
MSAs include two components:
A high-deductible health plan that offers your Medicare Advantage benefits.
A medical savings account where you can use money deposited in the account to pay for your health care needs until you pay off your deductible.
Each plan will include its own coverage structure, provider network and costs. Depending on the plan you choose, your benefits and out-of-pocket costs might vary.
You must have Original Medicare (both Parts A & B) before you can enroll in Medicare Advantage plans. Most people choose to enroll around the time they first qualify for Original Medicare. This is your initial enrollment period (IEP), a seven-month period surrounding your 65th birthday. However, some people also qualify for Special Enrollment Periods (SEPs) outside of their IEP.
Additionally, you can also join an Advantage plan during the annual Medicare Open Enrollment period which occurs from Oct. 15 – Dec. 7 each year. During this time, anyone with Medicare can enroll in, change or drop an Advantage plan.