HomeMedicareMedicare Advantage
Medicare Advantage plans in Chadds Ford, PA
Medicare Advantage (Part C) plans bundle your hospital, medical and usually prescription coverage into one plan from a private insurer. We help people in Chadds Ford and across Delaware and Chester Counties compare the plans available where they live.
How Medicare Advantage works
Medicare Advantage plans are offered by private insurance companies approved by Medicare. Instead of using Original Medicare, you get your Part A and Part B benefits through the plan, and most plans include Part D drug coverage too.
You'll still pay your Part B premium, plus the plan's premium if it has one. When you get care, you pay copays or coinsurance set by the plan, up to a yearly out-of-pocket maximum. Once you reach it, the plan pays for covered services for the rest of the year.
Many plans also add benefits Original Medicare doesn't cover, such as routine dental, vision and hearing care or fitness programs. What's included varies from plan to plan and county to county.
What's usually included
- Hospital and medical coverageEverything Parts A and B cover.
- Prescription drugsMost plans include Part D coverage.
- A yearly out-of-pocket limitSomething Original Medicare doesn't have.
- Extra benefitsOften dental, vision, hearing or fitness, depending on the plan.
HMO and PPO plans compared
Most Medicare Advantage plans in our area are HMOs or PPOs. The main difference is how strict the network is.
| HMO | PPO | |
|---|---|---|
| Doctors and hospitals | Use the plan's network, except for emergencies and urgent care. | Use the network for the lowest cost, or go out of network for a higher cost. |
| Primary care doctor | Usually required. | Usually not required. |
| Specialist referrals | Often required. | Usually not required. |
| Monthly premium | Often lower, including some $0 plans. | Often somewhat higher. |
| Best for | People whose doctors are all in one network and who want lower premiums. | People who want more flexibility, or who see doctors in more than one health system. |
Special Needs Plans (SNPs) are also available for people with certain chronic conditions, people who live in a facility, or people who have both Medicare and Medical Assistance.
Is Medicare Advantage a good fit for you?
Often a good fit if you
- Want lower monthly premiums and are comfortable with copays when you get care.
- Like having hospital, medical and drug coverage in one plan with one card.
- Want extras like dental, vision or hearing coverage.
- Have doctors who are all in the same plan's network.
Things to check first
- Whether your doctors, specialists and hospitals are in network, now and next year.
- Which services need prior authorization from the plan.
- How copays add up if you expect treatments, surgery or frequent visits.
- Coverage when you travel or spend part of the year out of state.
When you can join or switch
Plans change their premiums, networks and benefits every year, so it's worth reviewing your plan each fall.
Around your 65th birthday
Initial Enrollment Period
Join a plan when you first get Medicare, during the seven months around the month you turn 65.
October 15 to December 7
Annual Enrollment Period
Join, switch or drop a plan. Your new coverage starts January 1.
January 1 to March 31
Medicare Advantage Open Enrollment
Switch to a different Advantage plan, or return to Original Medicare, one time.
If your situation changes
Special Enrollment Periods
Moving, losing other coverage and some other events let you make changes during the year.
Each September your plan sends an Annual Notice of Change. Bring it to your review and we'll go through what's changing.
Medicare Advantage questions
Do I still pay my Part B premium with Medicare Advantage?
Yes. You keep paying your Part B premium, plus your plan's premium if it has one. Some plans have a $0 plan premium, but the Part B premium still applies.
What happens if I see a doctor outside the network?
With an HMO, you'll usually pay the full cost except for emergencies and urgent care. With a PPO, out-of-network care is covered but costs more. We'll check your doctors before you enroll.
Can I go back to Original Medicare later?
Yes, during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period. Keep in mind that buying a Medigap policy at that point may require answering health questions.
Is Medicare Advantage the same as Medicare Part C?
Yes. Part C is the official name for Medicare Advantage plans.
Does Medicare Advantage cover care when I travel?
All plans cover emergency and urgent care anywhere in the U.S. Routine care away from home depends on the plan, and PPO plans tend to be more flexible than HMOs.
Keep reading
Compare Medicare Advantage plans
We'll check your doctors, hospitals and prescriptions against the plans available in your county.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day, 7 days a week, to get information on all of your options.
Brandywine Insurance Group is an independent insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability, benefits and costs vary by plan and change each year.