YOUR GUIDE TO MEDICARE PLANS

MEDICARE ADVANTAGE PLANS

- Medicare Advantage Plans are also known as Part C these two terms are synonymous. 

- These plans cover all the services that Parts A and B of Original Medicare cover plus additional coverage that Original Medicare leaves out such as dental, vision, hearing, foot care, over the counter (OTC) products, and gym memberships. It is important to note that if Parts A and B of Original Medicare covers a service, than Medicare Advantage (Part C) must also cover that service at as good or better cost. 

- Medicare Advantage Plans must have an out-of-pocket maximum and lower coinsurance costs than Original Medicare this is required by federal law.

- Depending on the type of Medicare Advantage Plan, you may be restricted as to which providers you can see. This will be determined by the type of doctor network the plan you choose has. Some of the different types of doctor networks include: HMO, PPO, HMO-POS, PFFS, MSA and more. Check out our blog on different types of Medicare Advantage doctor networks to learn more. 

MEDICARE SUPPLEMENT PLANS

- Medicare Supplement Plans help to pay a lot of the healthcare costs that Original Medicare does not cover such as co-payments, coinsurance, and deductibles.  

- There are 10 Medicare Supplement Plans.

- Each plan is required to cover specific Original Medicare service costs.

- You will not need to worry about doctor networks. Your provider only needs to accept Original Medicare.

PRESCRIPTION DRUG PLANS 

- Prescription Drug Plans, also known as Part D plans, cover the cost of prescription drugs.

- It can be offered as a standalone plan or in conjunction with a Medicare Advantage plan called an MA-PD.

- These plans are only offered through private insurance companies. 

- These plans do have preset phases in which you will pay different amounts for your prescription drugs throughout the year. Check out our blog post on prescription drug phases to learn more. 

- There are late enrollment penalties for not signing up for a prescription drug plan when you first become eligible for Medicare. 

- The yearly cap that you could be liable for will change yearly and is controlled by the Centers for Medicare and Medicaid services (CMS). In 2026 the yearly cap for all Part D, Prescription Drug Plans is $2100. 

DUAL SPECIAL NEEDS PLANS

- Dual Special Needs Plans (D-SNPs) are Medicare Advantage Plans that are only available to those who are also on Medicaid.

- This plans will often provide extra benefits like rent, food, OTC, gas, utility and other allowances. They will also provide extra dental, vision, hearing coverage.

- These plans will typically have much lower if not $0 copays for most of your medical services and prescriptions if you qualify. 

 - To find out if you qualify call one of our licensed agents today or call your local state Health and Human Services number to get more information. 

CHRONIC SPECIAL NEEDS PLANS

- Chronic Special Needs Plans (C-SNPs) are Medicare Advantage plans that only available to those with certain chronic conditions. These plans will offer more services directed at your specific condition.

- These types of plans will typically give you a healthy food allowance along with lower copays related to your chronic condition. 

- The majority of these plans focus on chronic heart conditions or diabetes. While a few of these plans are offered to people with lung disorders or End Stage Renal Disease. 

- Some of these plans will have patient advocated tailored to your condition to help you throughout the year. 

- Please reach out to us if you think you may qualify.  

MEDICARE ADVANTAGE ONLY (MA-ONLY) PLANS

- Medicare Advantage, or MA-only, Plans are plans that do not include prescription drug coverage. These plans are offered to people who already have prescription drug coverage outside of Medicare. This includes those with TRICARE, those receiving VA benefits, or those who have creditable prescription drug coverage elsewhere.

- If you enroll into a Medicare Advantage Plan that does not include drug coverage, you cannot enroll into a standalone Part D plan at the same time. Therefore, if you have a Medicare Advantage Plan without drug coverage and do not have prescription coverage outside of Medicare you will incur a Late Enrollment Penalty if you join a Part D plan later on in life. This penalty will stay with you for as along as you keep the Part D plan. This is why is it very important to work with a broker that understand the rules.