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Medicare Advantage (Part C) is offered by private insurance companies in partnership with Medicare. It combines the coverage of Original Medicare (Parts A & B) into one comprehensive health plan for easier management and added benefits.
At Main Street Financial Partners, we help residents across Allentown, Bethlehem, Whitehall, Easton, Coopersburg, Saucon Valley, and Center Valley, as well as surrounding areas throughout the Lehigh Valley, Northampton County, Bucks County, Montgomery County, and Berks County.
Our team helps you understand your Medicare Advantage options, compare plan types, and find the best coverage for your healthcare needs.
Medicare Advantage Plans provide the same coverage as Original Medicare, except for hospice care, which remains covered under Part A. To enroll in a Medicare Advantage Plan, you must:
Participation is voluntary, but many choose it for convenience and added benefits. Private insurers offering these plans are approved by CMS (Centers for Medicare & Medicaid Services) and often include:
The popularity of Medicare Advantage continues to grow. Enrollment nearly doubled between 2010 and 2020, rising from 17% to over 36% of all Medicare beneficiaries, representing more than 24 million enrollees.
Choosing between Original Medicare and Medicare Advantage depends on your personal healthcare needs, lifestyle, and preferred network flexibility.
If you value convenience and comprehensive coverage, a Medicare Advantage plan could be the right choice for you.
There are several types of Medicare Advantage plans, each offering unique benefits and levels of flexibility.
Require members to use a network of approved healthcare providers. Referrals are typically needed to see specialists.
Offer flexibility to visit both in-network and out-of-network providers though in-network care usually costs less.
Determine how much the plan pays providers and how much you pay when receiving care. Providers must agree to the plan’s payment terms.
Designed for individuals with specific medical conditions or financial needs. These plans tailor coverage, networks, and drug formularies for specialized care.
Combine a high-deductible health plan with a medical savings account that Medicare funds annually. You can use this money to pay for qualified healthcare expenses.
Created for individuals who live in or are expected to live in long-term care facilities, such as nursing homes.
Selecting the right plan depends on your healthcare priorities, preferred providers, and budget.
To qualify for Medicare Advantage (Part C), you must already be enrolled in Medicare Parts A and B and reside in the plan’s service area.
Medicare Advantage enrollment is time-sensitive and follows specific periods each year.
A seven month window beginning three months before your 65th birthday, including your birthday month and ending three months after. This is the ideal time to enroll if you’re new to Medicare.
Held annually from October 15 to December 7, this period allows you to:
From January 1 through March 31, individuals already enrolled in a Medicare Advantage plan can:
Life changes may qualify you for a SEP outside the normal enrollment windows, including:
Selecting a Medicare Advantage Plan involves more than comparing prices, it’s about matching coverage to your unique health and lifestyle needs.
The advisors at Main Street Financial Partners provide personalized Medicare guidance for residents throughout the Lehigh Valley, Northampton County, Bucks County, Montgomery County, and Berks County, helping you evaluate plan options and enroll with confidence.
It bundles Part A and Part B—and often Part D—into one plan offered by private insurers approved by Medicare.
Advantage includes all Original benefits and may add dental, vision, hearing, fitness, and other extras.
You must have Parts A & B, live in the plan’s service area, and continue paying your Part B premium.
Most do (MAPD), but some do not. Always check the plan’s drug coverage and formulary.
HMO, PPO, PFFS, SNP, MSA, and I-SNP, each with different rules for networks, referrals, and costs.
Costs vary. You pay the Part B premium plus any plan premium and cost-sharing (copays/coinsurance).
IEP/ICEP (around 65), AEP (Oct 15–Dec 7), OEP (Jan 1–Mar 31), or a qualifying SEP.
Yes, during OEP or a qualifying SEP. You can add standalone Part D and consider Medigap.
Often in HMOs; PPOs usually don’t require referrals but encourage in-network care for lower costs.
We compare networks, benefits, costs, and drug coverage to match you with the right Medicare Advantage plan.
