Understanding the Basics of Medicare Advantage


Navigating the labyrinth of Medicare can seem like a daunting task, especially when you’re trying to decipher the differences between Original Medicare, Medicare Supplement (Medigap), and Medicare Advantage. It’s like trying to find your way through a complex maze without a map. But don’t worry, you’re not alone! At Sosa Insurance Group, we specialize in helping Medicare-eligible individuals in West Orange, NJ, and beyond, understand the basics of Medicare and make informed decisions about their healthcare coverage.

In this guide, we’ll take a deep dive into the world of Medicare Advantage, a popular choice among many seeking comprehensive, cost-effective coverage. With our expert guidance, you’ll learn what Medicare Advantage is, how it works, who’s eligible, and how it compares to other Medicare plans. We’ll also highlight how Sosa Insurance Group can assist you on your Medicare journey.

So, if you’re feeling overwhelmed by the complexity of Medicare and need assistance in choosing the right plan for your needs, read on. This guide is designed to provide you with the clarity you need to make an informed decision about your healthcare coverage.

What is Medicare Advantage?

Definition and Overview

In the labyrinth of healthcare coverage, Medicare Advantage, also known as Part C, stands out as a beacon of comprehensive and cost-effective coverage. It’s a type of health insurance plan provided by private companies that have received approval from Medicare. Unlike Original Medicare, which is directly managed by the federal government, Medicare Advantage Plans are an alternative way to receive your Medicare benefits.

How it Works

So, how does a Medicare Advantage Plan work? Essentially, when you join a Medicare Advantage Plan, you still remain in the Medicare Program. However, you get your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare.

The crux of it is that most Medicare Advantage Plans include prescription drug coverage (Part D), and many offer additional benefits that Original Medicare does not cover, such as vision, hearing, and dental services. Importantly, these plans can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care, offering you peace of mind and financial security.

Who is Eligible?

Eligibility for Medicare Advantage is relatively straightforward. If you have Part A and Part B, you can join a Medicare Advantage Plan. This is true even if you have a pre-existing condition.

However, there are some enrollment periods to be aware of. Typically, you can only join a Medicare Advantage Plan at certain times during the year, and once enrolled, you’re generally in the plan for a full year.

Moreover, it’s worth noting that you can only be in one Medicare Advantage Plan at a time. If your plan decides to stop participating in Medicare, you’ll need to join another Medicare Health Plan or return to Original Medicare.

Pinning down the basics of Medicare Advantage is the first step to navigate the maze of Medicare with confidence. The next sections will delve into the benefits of Medicare Advantage and how it compares to other Medicare Plans.

The Benefits of Medicare Advantage

Understanding Medicare can feel like untangling a complex knot. But don’t worry, breaking it down to the basics will make things much clearer. One of the most popular options for Medicare beneficiaries is Medicare Advantage, and for good reason. These plans, officially known as Part C, are a comprehensive, cost-effective, and often more inclusive alternative to Original Medicare.

Comprehensive Coverage

One of the primary attractions of Medicare Advantage plans is their comprehensive coverage. Unlike Original Medicare, which separates hospital insurance (Part A) and medical insurance (Part B), Medicare Advantage rolls these two coverages into a single plan. This means you have one source for all your healthcare needs.

Moreover, most Medicare Advantage plans also include prescription drug coverage (Part D), which is an additional benefit not included in Original Medicare. Having your hospital, medical, and prescription drug coverage under the same plan simplifies your healthcare navigation and can save you from having to manage multiple plans and providers.

Cost Efficiency

On the surface, choosing a Medicare Advantage plan might seem like an added expense. However, these plans can actually be more cost-effective than Original Medicare. While Original Medicare requires you to pay deductibles, copayments, and coinsurance for healthcare services, Medicare Advantage plans often have lower out-of-pocket costs and include an annual limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services, which significantly reduces your healthcare expenses.

Additional Benefits not Covered by Original Medicare

Perhaps the most enticing aspect of Medicare Advantage plans is the additional benefits they offer that Original Medicare does not. Many of these plans provide coverage for vision, hearing, and dental services, which are not covered by Original Medicare. Some plans might even offer wellness programs, gym memberships, or coverage for over-the-counter medications.

Additionally, some Medicare Advantage plans provide coverage for routine vision and dental care, further enhancing their appeal. So, not only can you receive the necessary medical and hospital coverage, but you can also take care of your eyes, teeth, and overall wellness.

The benefits of Medicare Advantage extend beyond just the basics. They offer a comprehensive, cost-effective, and inclusive healthcare solution that can make managing your healthcare simpler and more efficient. For those seeking an all-in-one solution for their Medicare needs, Medicare Advantage is worth considering. However, it’s vital to evaluate all your options and understand your specific healthcare needs before making a decision.

Comparing Medicare Advantage to Other Medicare Plans

Navigating the world of Medicare can be complex, but understanding the differences between various Medicare plan options can make the decision-making process easier. In this section, we’ll compare Medicare Advantage plans to Original Medicare, Medicare Supplement (Medigap), and Stand-Alone Part D Prescription Plans.

Medicare Advantage vs. Original Medicare

Medicare Advantage, also referred to as Part C, is an all-in-one alternative to Original Medicare. It includes both Part A (Hospital Insurance) and Part B (Medical Insurance), and most plans also include drug coverage (Part D) and additional benefits not covered by Original Medicare such as vision, hearing, and dental services1.

Original Medicare, on the other hand, is a fee-for-service plan managed by the federal government. It includes Part A (Hospital Insurance) and Part B (Medical Insurance), but does not include prescription drug coverage (Part D) or certain additional benefits such as vision, hearing, or dental2.

When comparing the two, it’s important to consider factors such as cost, coverage, and flexibility. Medicare Advantage plans often have lower out-of-pocket costs and offer more comprehensive coverage, but they may have more restrictions on the healthcare providers you can see1.

Medicare Advantage vs. Medicare Supplement (Medigap)

Medicare Supplement Insurance, also known as Medigap, is private insurance designed to supplement Original Medicare. These plans help cover the out-of-pocket costs of Original Medicare, such as deductibles, copayments, and coinsurance2.

One key difference between Medicare Advantage and Medigap is that you cannot have both. If you opt for a Medicare Advantage Plan, you are not allowed to purchase a Medigap policy. Conversely, if you have a Medigap policy and join a Medicare Advantage Plan, you’ll likely want to drop your Medigap policy since it can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums3.

Medicare Advantage vs. Stand-Alone Part D Prescription Plans

Stand-Alone Part D Prescription Plans are a way to add drug coverage to Original Medicare. These plans are offered by private companies approved by Medicare2.

A major benefit of Medicare Advantage plans is that most include prescription drug coverage, making a separate Part D plan unnecessary1. However, if you’re enrolled in Original Medicare and want prescription drug coverage, you’ll need to purchase a separate Part D plan.

In conclusion, comparing Medicare Advantage to other Medicare plans is an essential step in choosing the right healthcare coverage for your needs. It’s crucial to consider your healthcare needs, budget, and preferred healthcare providers when making your decision.


  1. Your coverage options | Medicare 2 3

  2. Understanding your Needs | Medicare Advantage and Supplement Plans 2 3

  3. Things to know about Medicare Advantage Plans | Medicare

How to Choose the Right Medicare Advantage Plan

As you navigate the complex world of Medicare, choosing the right Medicare Advantage Plan can seem daunting. However, with a strategic approach and a clear understanding of your healthcare requirements, you can find a plan that best suits your needs. Here are some crucial factors to consider when choosing a Medicare Advantage plan.

Factors to Consider

When evaluating different Medicare Advantage plans, you should assess the monthly premiums, copayments for various services, and out-of-pocket limits. Also, consider the costs of using non-network providers. Remember, each plan can have a different limit, which can change each year[^3^].

Another essential aspect to consider is the provider network of a plan. Some plans require you to use a network of doctors, hospitals, and other healthcare providers. If you have a preferred doctor or hospital, ensure they are included in the plan’s network[^2^].

Lastly, it’s crucial to consider the plan’s coverage area. Many Medicare Advantage plans only work in a specific state, region, or county[^2^]. If you live in another state part of the year, verify whether the plan will still cover you.

Understanding Your Healthcare Needs

The right Medicare Advantage plan should align with your unique healthcare requirements. Consider how often you visit the doctor or require medical services. For instance, with Original Medicare, you pay 20% of the allowed amount for most doctor services after meeting the Part B deductible. In contrast, most Medicare Advantage plans charge a low copayment for each visit[^2^].

It’s also crucial to verify whether the medications you regularly take are covered. Most prescription drug plans and Medicare Advantage plans that include drug coverage have a list of covered drugs, or formulary[^2^].

Evaluating Plan Options

Medicare Advantage plans come in various types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), and Special Needs Plans[^1^]. Each type has unique features, benefits, and limitations.

For instance, some plans offer additional benefits not covered by Original Medicare, such as vision, hearing, and dental services[^3^]. Some plans may not charge any monthly premium, while others offer an annual out-of-pocket limit for financial protection[^3^].

In summary, choosing the right Medicare Advantage plan involves a thorough evaluation of various factors and a clear understanding of your healthcare needs. By considering your healthcare usage, coverage requirements, and financial situation, you can find a Medicare Advantage plan that fits your needs like a glove. Remember, the Sosa Insurance Group is here to assist you throughout your Medicare journey. Don’t hesitate to reach out for personalized guidance and support.

The Role of Sosa Insurance Group in Your Medicare Journey

Choosing the right Medicare Advantage Plan can often feel like navigating a labyrinth. But with the Sosa Insurance Group by your side, the path to finding the perfect Medicare plan becomes clear and manageable.

How Sosa Insurance Group Can Help

The Sosa Insurance Group is a leading insurance brokerage agency in New Jersey, whose goal is to streamline the process of choosing a suitable Medicare Advantage Plan for you. With a team of experienced professionals, they use their expertise to help simplify the complex world of Medicare. They provide individual consultations, going through your options step-by-step, and comparing them to your medical history to determine the coverage you need. Their aim is to ensure you have the right coverage for your situation without paying for anything unnecessary.

Services Offered by Sosa Insurance Group

The Sosa Insurance Group offers a wide array of services to assist you with your Medicare needs. They offer guidance on the different types of Medicare Advantage Plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Special Needs Plans (SNPs), Medicare Medical Savings Accounts (MSAs), and Private Fee-for-Service Plans (PFFS).

Beyond this, the Sosa Insurance Group also offers services related to other Medicare health plans, such as Medicare Cost Plans, demonstration/pilot programs, and the Program of All-inclusive Care for the Elderly (PACE). They are there to help you understand the specifics of each plan and how they can cater to your healthcare needs.

Why Choose Sosa Insurance Group?

When it comes to making crucial decisions about your healthcare, you want to be sure you’re in the hands of someone you can trust. The Sosa Insurance Group has proven itself to be a reliable partner in the Medicare journey. They prioritize helping individuals and families find the right health insurance coverage that suits their specific needs at an affordable price.

Their commitment to keeping you informed throughout the application process and their dedication to saving you money sets them apart in the industry. The Sosa Insurance Group doesn’t just provide a service—they provide a partnership, working alongside you to ensure you get the healthcare coverage you deserve.

When it comes to understanding the basics of Medicare Advantage and making an informed decision, the Sosa Insurance Group is your go-to resource. Their commitment to individualized service, comprehensive knowledge of Medicare plans, and dedication to their clients’ needs make them a preferred choice for Medicare-eligible individuals in West Orange, NJ and beyond.


As we demystify the complexities of Medicare, it’s clear that Medicare Advantage Plans offer comprehensive coverage that goes beyond the scope of Original Medicare. Commonly referred to as Part C, these plans combine Part A (Hospital Insurance) and Part B (Medical Insurance) benefits and often include Part D (Prescription Drug Coverage). Importantly, they may also extend to services not covered by Original Medicare, such as vision, hearing, dental care, and even fitness programs.

Remember, informed decisions lead to better healthcare outcomes. Understanding the nuances of Medicare Advantage Plans, including their benefits, cost-efficiency, and eligibility criteria, is crucial. Equally important is knowing how they compare to other Medicare options like Original Medicare, Medicare Supplement (Medigap), and Stand-Alone Part D Prescription Plans.

But you don’t have to navigate this complex terrain alone. The Sosa Insurance Group is here to guide you every step of the way. As a leading insurance brokerage agency specializing in Medicare Health Plan Insurance, we’re dedicated to helping you find a plan that best fits your needs, at a price you can afford.

Remember, choosing the right Medicare plan is not just about cost – it’s about ensuring your health and wellbeing. With our expert consultations, we’ll help you understand the ins and outs of Medicare Advantage Plans, so you can make a choice that aligns with your healthcare needs, lifestyle, and budget.

Reach out to the Sosa Insurance Group today. Our team of experts is ready to help you navigate your Medicare journey with ease and confidence. Call us at 800-552-1934 or email us at info@thesosainsurancegroup.com. We’re here to help you every step of the way.