What is the difference between Medicare Advantage and Original Medicare?

Original Medicare consists of Part A and Part B, offered directly through the federal program, and typically does not include prescription drug coverage or extra benefits. Medicare Advantage (Part C) is offered by private insurance companies and generally combines Part A and Part B coverage, often with Part D and additional benefits included.

Does Medicare Advantage include prescription drug coverage?

Most Medicare Advantage Plans include Medicare Part D prescription drug coverage, but not all do, so it's important to confirm this and review the plan's drug formulary before enrolling.

Is there a limit to how much I could pay out of pocket in a year?

Medicare Advantage Plans include an annual maximum out-of-pocket limit for covered Part A and Part B medical services. Once that limit is reached, you pay nothing more for those covered services for the rest of the calendar year. Prescription drug costs are generally tracked separately.

When can I enroll in or switch a Medicare Advantage Plan?

You can generally enroll during your Initial Enrollment Period around your 65th birthday, during the Annual Enrollment Period each October 15 through December 7, or during a Special Enrollment Period if you qualify due to a life event.

Can plan benefits and costs change from year to year?

Yes. Medicare Advantage Plans can change their premiums, benefits, cost-sharing and provider networks annually, which is why many people review their coverage each year during the Annual Enrollment Period.

Medicare

Medicare Advantage (Medicare Part C)

One plan that can combine your hospital, medical and drug coverage

Medicare Advantage Plans are offered by private insurance companies approved by Medicare and are built to include everything in Original Medicare, often with extra benefits layered on top.

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In plain language

Medicare Advantage Plans include all the benefits of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Many plans also add coverage for dental, vision and hearing services, and most include Medicare Part D prescription drug coverage as well.

Because these plans are provided by private insurance companies, costs and coverage details can vary by plan, carrier and location. Each plan may set its own premiums, deductibles, copayments and provider network.

Who this may be for

People newly eligible for Medicare who want their hospital, medical and often drug coverage combined into a single plan.
Those who want the option of additional benefits, such as dental, vision or hearing coverage, that Original Medicare does not include.
People who want the predictability of an annual maximum out-of-pocket limit for covered medical services.
Anyone comparing Medicare Advantage against Original Medicare with a separate Medigap and Part D plan.

What it generally covers

All benefits included under Medicare Part A (hospital insurance).
All benefits included under Medicare Part B (medical insurance).
Prescription drug coverage under Medicare Part D, included with most (though not all) plans.
Additional benefits some plans may offer, such as dental, vision and hearing services.
An annual maximum out-of-pocket limit for covered Part A and Part B medical services, after which you pay nothing for those covered services for the rest of the calendar year.

Coverage, costs and availability vary by policy, carrier, eligibility and location. The details above are educational and are not a description of any specific plan.

Not sure whether medicare advantage (medicare part c) fits your situation?

Consultations are offered at no cost and without obligation. Submitting a form does not enroll you in coverage.

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Important choices and considerations

Things to review before enrolling

Provider networks: confirm your preferred doctors, hospitals and specialists participate in the plan's network.
Prescription drug coverage: if the plan includes Part D, review its formulary to confirm your medications are covered.
Plan costs and benefits: compare premiums, copays, deductibles and any extra benefits such as dental, vision or hearing coverage.
Annual plan changes: Medicare Advantage Plans can change their costs, benefits and provider networks each year, so it's worth reviewing your plan annually.

Enrollment periods for Medicare Part C

Initial Enrollment Period (IEP): a seven-month window that begins three months before the month you turn 65, includes your birth month, and ends three months after.
Medicare Annual Enrollment Period (AEP): runs each year from October 15 through December 7, during which you can join, switch or drop a Medicare Advantage Plan.
Special Enrollment Periods (SEPs): certain life events, such as moving to a new service area, losing other coverage, or qualifying for Extra Help, may allow enrollment or changes outside the standard windows.

Potential limitations and exclusions

Medicare Advantage Plans are offered by private insurers, so exact costs, benefits and networks vary and are not guaranteed to match Original Medicare's structure.
Prescription drug costs under a plan's Part D benefit are generally not included in the medical out-of-pocket maximum and may have separate cost-sharing.
Plans generally require using in-network providers for full benefits, and networks can change from year to year.
Enrolling in a Medicare Advantage Plan typically means you are not eligible to also hold a Medigap policy unless you switch back to Original Medicare.

How Bleu Sky's helps

Help you understand your Medicare options and eligibility.
Review plan costs, benefits and coverage choices with you.
Help you understand rules around avoiding late enrollment penalties.
Help you find a plan that fits your health needs and budget.

What happens next

1
Tell us what you need
Share your situation in a short conversation. No sensitive information required.
2
Review your options
A licensed advisor walks you through the choices available to you in plain language.
3
Choose with confidence
Decide at your own pace. We stay available after you enroll.