Frequently Asked Questions
Common questions about Medicare Advantage, working with an agent, and the enrollment process.
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare covers, and most also include extra benefits like dental, vision, hearing, and prescription drug coverage.
The main differences: Medicare Advantage plans use provider networks and typically have an annual out-of-pocket maximum, while Original Medicare allows you to see any provider that accepts Medicare but has no out-of-pocket cap.
Many Medicare Advantage plans have $0 monthly premiums. You still pay your Part B premium to Medicare. Beyond that, costs vary by plan and include copays for doctor visits, prescriptions, and other services. Every plan has an annual out-of-pocket maximum that caps what you pay in a year.
A licensed agent can help you compare total costs across plans based on your specific healthcare usage.
It depends on the plan. Each Medicare Advantage plan has a network of providers. Before enrolling, you should verify that your primary care physician and any specialists you see regularly are in the plan's network.
HMO plans generally require you to use in-network providers, while PPO plans allow out-of-network visits at a higher cost. A local agent can help you check provider directories for plans in your area.
There are several enrollment periods:
- Initial Enrollment Period: Seven months around your 65th birthday.
- Annual Enrollment Period: October 15 through December 7 each year.
- Open Enrollment Period: January 1 through March 31 (for those already in a Medicare Advantage plan).
- Special Enrollment Periods: Triggered by qualifying life events like moving or losing employer coverage.
Licensed Medicare agents are compensated by the insurance carriers, not by you. There are no fees, charges, or commissions that come from your pocket. The plan you choose costs the same whether you enroll through an agent, directly with the carrier, or through Medicare.gov.
Before discussing specific plan details, Medicare requires a Scope of Appointment (SOA) form. This form simply confirms what types of products we will discuss and protects your rights as a beneficiary. It must be completed at least 48 hours before a scheduled appointment.
It does not obligate you to enroll in anything.
To make the most of your consultation, have the following ready:
- Your Medicare card (or Medicare number)
- A list of your current medications (including dosages)
- The names of your doctors and any specialists you see regularly
- Any questions you have about your coverage needs or budget
Yes. During the Annual Enrollment Period (October 15 through December 7), you can switch to a different Medicare Advantage plan or return to Original Medicare. If you are already enrolled in a Medicare Advantage plan, you can also make one change during the Open Enrollment Period (January 1 through March 31).
Certain life events may also qualify you for a Special Enrollment Period.
No. This website is operated by a licensed, independent Medicare insurance agent. It is not affiliated with or endorsed by Medicare, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS), or any government agency.