Understanding Medicare Advantage Plans

Medicare Advantage vs Medigap

Understanding Medicare Advantage Plans

We are all aware that Original Medicare is a federal health insurance program available to anyone turning 65. Original Medicare consists of two parts:

  1. Part A (hospital insurance) covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care.
  2. Part B (Medical Insurance) covers doctor appointments, outpatient services, medical equipment, home health care, and some preventative services.

Many people, including your clients, may not be aware that Medicare Part A and Part B does NOT cover drug prescriptions, dental, vision, hearing, or long-term care. This is where Medicare Advantage comes in, which is often referred to as Part C.

People with Original Medicare who are looking to fill gaps in their coverage can enroll in a Medicare Advantage plan. These plans are offered by private insurance companies that contract with Medicare to provide all of your Part A & B benefits. The most common types of Medicare Advantage plans are:

  • Health Maintenance Organizations (HMO)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNP)
  • Medical Savings Accounts (MSA)

Most Medicare Advantage plans offer prescription drug coverage (also known as Part D), along with vision, hearing, and dental coverage. Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans, and they must follow rules set by Medicare. To be clear, if your clients choose to enroll in a Medicare Advantage plan it will replace Medicare Part A and B and serve as their sole plan.

Medicare Advantage plans typically come with deductibles and co-pays, but unlike Original Medicare, Medicare Advantage has an annual out-of-pocket limit. Meaning that once your clients pay deductibles and co-pays that add up to the annual out-of-pocket limit, the plan will pay 100% of their medical bills for the rest of the year. Out-of-pocket expenses may add up for some people, so an out-of-pocket limit can save money and also offer peace-of-mind.

Not all Medicare Advantage Plans work the same way and it is recommended to take the time to find and compare Medicare health plans in your clients area. Medicare can be complicated and it is easy to miss important details without professional help leading to dissatisfaction with the plan. But it’s not the fault of the plan, it is simply that many people do not know the rules of the plan before they enroll. All too often Medicare beneficiaries try to enroll in coverage on their own without the free help from a Medicare insurance broker like Empower Brokerage. There are many different Medicare Advantage plans available, and an agent from Empower Brokerage can help beneficiaries shop around. As agents, we consider client lifestyle, health condition, and finances while searching for a Medicare Advantage plan to best fit our clients needs in their area.

What About Medigap? What Is That?

Medigap, also known as Medicare Supplement, is another type of private Medicare insurance that helps fills gaps in Original Medicare coverage – similar to Medicare Advantage. While Medigap only supplements Original Medicare benefits, Medicare Advantage plans are ways to get Medicare benefits. The top advantage of Medicare Advantage is the price. Monthly premiums are typically lower than Medigap. However, not all hospitals and doctors accept Medicare Advantage, and plans often cover fewer expenses. When it comes to which plan is more comprehensive, Medigap has more overall coverage but typically cost more.


The table below compares Original Medicare with a Medigap vs Medicare Advantage and can help with Understanding Medicare Advantage Plans. It’s a good resource to have when talking to your clients about the differences. Remember there are several different kinds of plans.

Empower Brokerage is dedicated to helping you educate your clients on the insurance they need to get the most out of life. Whether it’s through webinar training, one-on-one calls, seminars, or marketing plans. We want you to be successful. Give us a call if you have any questions 888-539-1633.

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Medigape vs Medicare Advantage