Original Medicare (Parts A & B)
Original Medicare is the government-run health insurance program for people 65 and older and those with certain disabilities. It includes Part A (Hospital Insurance) for inpatient care and Part B (Medical Insurance) for doctor visits, outpatient care, and preventive services.
While it covers many essential healthcare needs, it does not include prescription drugs, dental, vision, or hearing coverage, and there is no cap on out-of-pocket costs—which is why many people choose to add Medicare Advantage, Medigap, or Part D plans for more complete coverage.
What's Covered
Part A
Hospital Insurance
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Hospital Stays
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Hospice
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Some Skilled Nursing Services
Part B
Medical Insurance
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Doctor Visits
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Outpatient Care
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Preventative Services
What's Not Covered
Dental & Vision
Prescription Drugs
Long-term Care
Your Stellar Health Journey Begins Here!
1
Give us a Call
Start with a free, no-obligation consultation. We’ll take the time to understand your needs and answer any questions about Medicare, individual health plans, or small business coverage.
2
Explore Your Options
We’ll walk you through plans from top insurance providers, breaking down your choices so you can find the right coverage at the right price—without the confusion.
3
Get Enrolled
Once you’ve chosen a plan, we’ll guide you through the enrollment process—making it simple, stress-free, and ensuring everything is done correctly.
Medicare Advantage (Part C)
Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare, offered by private insurance companies approved and regulated by Medicare. These plans combine hospital (Part A) and medical (Part B) and most often Prescription Drug (Part D) coverage into one single plan. They often including extra benefits like dental, vision, hearing, and fitness programs.
Most Medicare Advantage plans operate through HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations), meaning you’ll typically use a network of doctors and hospitals for lower costs.
All-in-One Coverage with Extra Benefits
Combines Hospital & Medical
(Part A & B)
Often Includes Prescription Drug Coverage (Part D)
Extra Benefits: Dental, Vision, Hearing and more
Fixed Out-of-Pocket Maximums for Cost Control
Many plans bundle medication coverage with health benefits, so you don’t need a separate drug plan.
Unlike Original Medicare, Medicare Advantage has an annual cap on how much you pay for covered services. Once you hit that limit, your plan covers the rest for the year. Many plans offer dental, vision, hearing, fitness programs, and even transportation services—benefits Original Medicare doesn’t include.
Veteran-Focused Medicare Plans
At Stellar Health Benefits, we proudly serve those who served by offering Medicare Advantage plans designed to complement VA and TRICARE benefits—not replace them. These plans help you get more from your coverage with added flexibility and features. Learn more about veteran Medicare options.
When Can You Enroll?
Beneficiaries can join, switch, or disenroll from Medicare Advantage plans during certain enrollment periods:
Initial Coverage Election Period (ICEP)
Begins three months before turning 65 and lasts for seven months.
Annual Enrollment Period (AEP)
Oct 15 to Dec 7, during which beneficiaries can make changes to plans, and choose different carriers.
Open Enrollment Period
Jan 1 to Mar 31, during the enrollment period for Medicare Advantage Plans (with or without drug coverage), you have the option to: Switch to another Medicare Advantage Plan (with or without drug coverage), Drop your Medicare Advantage Plan and return to Original Medicare, while also being able to join a separate Medicare drug plan.
However, During this Period, You Cannot:
Switch from Original Medicare to a Medicare Advantage Plan, Join a separate Medicare drug plan if you have Original Medicare, Switch from one Medicare drug plan to another if you have Original Medicare. You're allowed only one change during this period, and any changes made will take effect the first of the month after your request is received. If you're returning to Original Medicare and joining a separate Medicare drug plan, disenrollment from your Medicare Advantage Plan will occur automatically upon joining the drug plan.
Network Coverage: It's essential for beneficiaries to review the network of doctors, hospitals, and other healthcare providers included in a Medicare Advantage plan. Using providers outside the plan's network may result in higher out-of-pocket costs.
Cost Sharing: Medicare Advantage plans often have different cost-sharing structures, but they are required by law to offer coverage that is equal to or better than Original Medicare, including copayments and coinsurance for services. These costs can vary depending on the plan and the type of service received.
Switching between Original Medicare and Medicare Advantage: If a beneficiary is enrolled in a Medicare Advantage plan and wishes to return to Original Medicare, they can do so during the Medicare Advantage Disenrollment Period (MADP), which occurs from January 1 to February 14 each year. They can then join a standalone Medicare Part D plan for prescription drug coverage.
Medicare Advantage plans offer an alternative way for Medicare beneficiaries to receive their healthcare benefits, providing coverage that includes Part A, Part B, and sometimes Part D benefits, along with additional benefits not available in Original Medicare. Before enrolling in a Medicare Advantage plan, it's crucial for beneficiaries to carefully review the plan's terms and conditions, coverage options, network providers, and costs to find the best fit for their specific healthcare needs.
Your Guide to Medicare Health Plans in Pennsylvania
Medicare comes with multiple options and choosing the right one can feel overwhelming. But you don’t have to figure it out alone! At Stellar Health Benefits, we’re Medicare experts and are here to simplify the process and guide you through your options.
Whether you're looking for comprehensive health coverage, cost-saving Medigap supplements or prescription drug plans, we’ll help you compare, understand, and enroll with no additional costs to you. Stellar Health Benefits offers Medicare plans from top insurers in the area including Aetna, AllWell, Cigna, Geisinger, Highmark, Humana, New Era, Peak Health, United Health Care and UPMC.
Get Stellar Guidance and Find the Right Plan with Confidence.
Feature | Original Medicare (Parts A & B) | Medicare Advantage (Part C) |
|---|---|---|
Referrals Needed? | No | Sometimes but not often required for specialists |
Costs | 20% coinsurance with no out-of-pocket max - the bills keep coming | May have lower costs, but with network restrictions and a definite out of pocket max. |
Extra Benefits | No dental, vision or hearing | May include dental, vision, hearing, fitness programs, etc. |
Prescription Drugs | Requires separate Part D plan | Often includes Part D |
Coverage | Part A (hospital) & Part B (medical) 20% Coinsurance | Includes Parts A, B, & most often Part D (prescriptions) |
Provider Network | Any doctor/hospital that accepts Medicare | Limited to network providers (HMO/PPO) you will save money by staying in network |
Quick Comparison Chart
Original Medicare (Parts A & B) and Medicare Advantage (Part C) both provide essential healthcare benefits, but they work differently in terms of cost, provider networks, and coverage options. The chart below breaks down the key differences to help you decide which option best fits your needs.
Medicare Supplement or Medigap Insurance
Medigap plans are private health insurance policies that are designed to work as a secondary insurance alongside Original Medicare (Part A and Part B). These plans are offered by private insurance companies and are designed to help cover most of the out-of-pocket costs that beneficiaries would otherwise incur with Original Medicare alone.
How Medigap Plans Work
Coverage of Cost Sharing:
Medigap plans help pay for certain costs that beneficiaries are responsible for under Original Medicare, such as deductibles, copayments, and coinsurance. Depending on the specific Medigap plan, it may cover some or all of these expenses.
Standardized Plans
Medigap plans are standardized and labeled with letters, from Plan A to Plan N (excluding Plan E, H, I, and J). Each plan with the same letter provides the same basic benefits, regardless of the insurance company offering it. For example, Medigap Plan F provides the same benefits, no matter which insurance company sells it.
Enrollment Eligibility
To be eligible for a Medigap plan, beneficiaries must be enrolled in both Medicare Part A and Part B. It's essential to apply for a Medigap policy during the Medigap Open Enrollment Period, which lasts for six months and begins on the first day of the month in which the beneficiary is age 65 or older and enrolled in Part B. During this period, insurance companies cannot deny coverage or charge higher premiums based on health conditions.
Coverage Differences Between Medigap Plans
While Medigap plans with the same letter offer the same basic benefits, the premiums may vary between insurance companies. Some Medigap plans may offer additional benefits beyond the standardized coverage, such as coverage for foreign travel emergencies or excess charges that doctors may charge above the Medicare-approved amount.
Important Points About Medi-Gap Insurance
Does Not Include Prescription Drug Coverage: Medigap plans do not provide coverage for prescription drugs. If beneficiaries want prescription drug coverage, they must enroll in a separate Medicare Part D prescription drug plan.
Individual Coverage
Medigap policies generally only cover one individual. If a spouse also wants Medigap coverage, they would need to purchase a separate policy.
Renewability
As long as beneficiaries pay their premiums, Medigap policies are guaranteed renewable, which means the insurance company cannot cancel the policy, even if the beneficiary has health issues.
Medigap & Medicare Advantage are Incompatible
It's important to note that Medigap plans cannot be used with Medicare Advantage plans. If a beneficiary chooses a Medicare Advantage plan, they should not purchase a Medigap policy, as it will not work with the Medicare Advantage plan.
While Medigap plans with the same letter offer the same basic benefits, the premiums may vary between insurance companies. Some Medigap plans may offer additional benefits beyond the standardized coverage, such as coverage for foreign travel emergencies or excess charges that doctors may charge above the Medicare-approved amount.
Prescription Drug Coverage (Medicare Part D)
Medicare Part D is prescription drug coverage available to anyone with Medicare. It helps lower the cost of medications and is offered through private insurance companies approved by Medicare.
You can enroll in a standalone Part D plan to pair with Original Medicare or choose a Medicare Advantage plan that includes drug coverage—ensuring you have access to the prescriptions you need at an affordable cost.
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Helps Cover Medication Costs
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Each Plan Covers Different Drugs
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Standalone or Included in Part C
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Annual Enrollment Required