Frequently Asked Questions

Medicare Advantage

The Medicare Advantage plan receives funding from the government as it agreed to pay your medical claims. In other words, your claim is the responsibility of the Part C insurance carrier.

You don’t need to. It’s your choice to decide if you’d like to be on Original Medicare or sign up for Medicare Advantage Plan (Part C) or Medicare Supplement (Medigap). Be mindful of the deductibles and copayments if you choose to stay on Original Medicare with no additional medicare insurance coverage. As well as the late enrollment penalty if you don’t have creditable prescription drug coverage.

No, they are not the same. You leave Original Medicare when you sign up for Part C, while Medigap/Medicare Supplement plans work with Original Medicare to provide you more comprehensive benefits than Original Medicare has to offer.

You must have both Medicare Part A and Part B and live in the service area in order to enroll in a Medicare Advantage plan.

With a PPO, it is not required to have a designated primary care physician (PCP) and you can see a specialist without a referral from your PCP. With HMO you have to see the providers who are in the network only, unless in a medical emergency; while with PPO gives you an option to see out-of-network providers (for a higher rate)

  • With Original Medicare, your benefits are administered by the federal government, unlike Medicare Advantage where the benefits are managed through a private insurance company. Medicare pays the Medicare Advantage carrier to administer your benefits.
  • Original Medicare has no network limitations. Medicare Advantage has limited doctor networks and when you need to see a specialist with a small network, access to care can be more challenging.
  • Most Medicare Advantage plans offer benefits beyond what Original Medicare covers like gym membership, over the counter (OTC) allowance, dental, hearing, vision, and transportation to doctor visits.
  • Medicare Advantage PPO comes with a limited network of providers. You will still have an option to see out-of-network providers, however you will pay higher coinsurance. Medicare Supplement (Medigap) has no network; it gives you freedom to choose any provider in the US that accepts Medicare assignment.
  • Unlike Medicare Advantage PPO, most Medicare Supplement plans don’t have copayments or coinsurance. However the Medicare Supplement monthly premium is generally higher than Medicare Advantage PPO.
  • Most Medicare Advantage PPO plans do include Medicare Part D (Prescription Drug), while Medicare Supplement plans don’t.
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