What Exactly Is a Medicare Advantage Plan?
Think of a Medicare Advantage plan, also known as Part C, as a bundled alternative to Original Medicare. It’s not an extra plan you add on; it’s a plan you choose instead of having Original Medicare Parts A and B as your primary coverage. Private insurance companies, approved by Medicare, offer these plans. By law, they must cover everything that Original Medicare covers, but they do it with a different cost structure. Instead of deductibles and 20% coinsurance, you'll typically have a schedule of copayments for doctor visits, hospital stays, and other services. Most Medicare Advantage plans in Elyria also include prescription drug coverage (Part D), so you have one card and one plan for most of your healthcare needs. Many plans also offer extra benefits not covered by Original Medicare, like routine dental, vision, hearing exams, and gym memberships. These plans manage your care, often using local provider networks like an HMO or a PPO. This means you may need to use specific doctors and hospitals, like University Hospitals Elyria Medical Center, if they are in your plan’s network.
How Is a Medigap Plan Different?
A Medigap plan, also called a Medicare Supplement, works alongside Original Medicare, not in place of it. Its only job is to pay for the costs that Medicare Parts A and B leave behind—the “gaps” in coverage. These gaps include deductibles, copayments, and coinsurance. When you see a doctor or go to the hospital, Medicare pays its share first, and then your Medigap plan pays its share, often leaving you with little to no out-of-pocket costs for Medicare-covered services. This creates highly predictable healthcare expenses. Unlike Medicare Advantage, Medigap plans are standardized by the federal government. This means a Plan G from one company has the exact same core benefits as a Plan G from another company; only the premium and company service differ. Medigap plans do not include prescription drug coverage, so you must purchase a separate standalone Part D plan. They also don't offer extra benefits like dental or vision. The key feature is freedom: you can see any doctor or visit any hospital in the United States that accepts Medicare, with no network restrictions or referral requirements.
Comparing Advantage vs. Medigap in Elyria
When you compare these options side-by-side, the trade-offs become clear. The most obvious difference is cost structure. Medicare Advantage plans in Lorain County often have very low or even $0 monthly premiums, but you pay for services as you use them through copays and coinsurance until you reach an annual out-of-pocket maximum. With Medigap, you pay a higher, fixed monthly premium for your plan and a separate premium for a Part D drug plan. In return, your out-of-pocket costs for medical services are extremely low, or even zero for the year. The second major difference is provider access. An Elyria resident with a Medigap plan can see specialists at Mercy Health Lorain, doctors at the Cleveland Clinic, or even a provider in Florida while visiting family, as long as they accept Medicare. Someone with an HMO-style Advantage plan would be limited to a specific network of local doctors and hospitals. PPO Advantage plans offer more flexibility to go out-of-network, but usually at a higher cost. Finally, consider simplicity versus customization. Advantage plans bundle medical, drug, and often extra benefits into one package. Medigap requires you to assemble your coverage: Original Medicare + Medigap plan + Part D plan. This allows for more customization but also requires managing three separate parts.
Talk to a licensed Northeast Ohio Medicare agent — free
Get plan options matched to your ZIP, doctors, and prescriptions. Callback within 24 hours.
or call (234) 380-6282 — United Medicare Club, our partner agency
Who Is a Good Fit for a Medicare Advantage Plan?
A Medicare Advantage plan is often a good fit for individuals who are relatively healthy, budget-conscious, and comfortable with using a provider network. Consider a newly retired teacher from Carlisle Township. She doesn't have many recurring medical needs and wants to keep her fixed monthly expenses as low as possible. A $0-premium Medicare Advantage PPO plan seems attractive. It includes prescription coverage and some dental and vision benefits, saving her from buying separate policies. She's checked to make sure her family doctor and the specialists she sees occasionally are in the plan's network, so she isn't concerned about access. She understands that if she develops a serious health condition, she will have copays for hospital stays, specialist visits, and diagnostic imaging, but she is comfortable with that risk in exchange for the low upfront cost. For many Elyria residents who plan to receive most of their care locally and value the simplicity of a bundled plan with extra perks, Medicare Advantage can be an excellent and affordable choice.
Who Should Consider a Medigap Plan?
A Medigap plan tends to appeal to those who prioritize predictable costs and freedom of choice in their healthcare. Let's imagine a 68-year-old man from the west side of Elyria who was just diagnosed with a chronic condition. He needs to see a team of specialists, and his cardiologist's main office is at a hospital outside his immediate area. He also spends a few months each winter in a warmer state. For him, a Medigap plan is ideal. He's willing to pay a higher monthly premium because he knows that his numerous doctor visits and potential hospitalizations will be covered with almost no out-of-pocket costs. He never has to worry about whether a doctor accepts his specific plan, only whether they accept Medicare. This freedom gives him the ability to seek a second opinion from any specialist in the country without a referral or network penalty. People who travel frequently or simply want to eliminate the worry of unpredictable medical bills often find the higher premium of a Medigap plan to be a worthwhile investment for their financial security.
Key Rules for Switching and Common Mistakes to Avoid
Understanding the rules for enrolling and switching is critical. When you first become eligible for Medicare Part B, you have a six-month Medigap Open Enrollment Period. During this window, you have a guaranteed right to buy any Medigap plan sold in Ohio, regardless of your health history. If you miss this window and try to buy a Medigap plan later, insurance companies can generally use medical underwriting, meaning they can charge you more or deny coverage based on pre-existing conditions. This is a crucial point many people miss. In contrast, you can switch from one Medicare Advantage plan to another every year during the Annual Enrollment Period (Oct 15 - Dec 7) without any medical questions. A common mistake is choosing an Advantage plan initially to save money, then trying to switch to Medigap years later after a health issue arises, only to find it's unaffordable or unavailable. Another pitfall is enrolling in a Medigap plan and forgetting to sign up for a separate Part D plan, which can lead to a permanent late enrollment penalty. For official government information, you can always contact the Western Reserve Area Agency on Aging OSHIIP counselors or visit the Social Security office in Sheffield Village for help with your Part B enrollment. For personalized assistance comparing specific plans in Elyria, we are here to help. Using the callback form on this page is the best way to get started with no obligation.
Frequently asked questions
Can I have both a Medigap plan and a Medicare Advantage plan at the same time?
No, you cannot. It is illegal for an insurance company or agent to sell you a Medigap plan if they know you are enrolled in a Medicare Advantage plan. These two types of coverage work in fundamentally different ways. Medicare Advantage plans replace your Original Medicare benefits, while Medigap plans supplement them. You must choose one path or the other. If you have a Medigap plan and decide to join a Medicare Advantage plan, you should drop your Medigap policy once your Advantage coverage is confirmed to begin.
Do doctors at UH Elyria Medical Center accept both types of plans?
University Hospitals Elyria Medical Center accepts Original Medicare. Therefore, if you have a Medigap plan, you can receive services there, as Medigap follows Medicare. For Medicare Advantage, the answer is more specific. You must check the provider directory for the exact Medicare Advantage plan you are considering. While many plans in Lorain County will include UH Elyria in their network, some may not. It's critical to verify network participation for not just the hospital, but also for your specific doctors, before enrolling in any Medicare Advantage plan.
What if I choose a Medicare Advantage plan in Elyria and end up disliking it?
You have options. If you're new to Medicare and chose an Advantage plan, you have a 12-month 'trial right' period. During this time, you can switch back to Original Medicare and have a guaranteed right to purchase a Medigap plan. Additionally, every year during the Annual Enrollment Period (AEP) from October 15 to December 7, you can switch from your current Advantage plan to a different one or return to Original Medicare. There is also an Open Enrollment Period from January 1 to March 31 for those already in an Advantage plan to make a one-time switch.
How can some Medicare Advantage plans have a $0 monthly premium?
This is a common and excellent question. Medicare pays private insurance companies a fixed monthly amount for each person who enrolls in one of their Medicare Advantage plans. This government payment allows the company to cover your Part A and B services. By managing care through networks and using cost-sharing like copays, they can often offer plans with very low or even $0 premiums. It's important to remember that you must still be enrolled in and continue to pay your monthly Medicare Part B premium to the government, even with a $0 premium Advantage plan.
Is it difficult to switch from Medicare Advantage back to Original Medicare with Medigap?
It can be, depending on your timing and health. If you are past your initial Medicare eligibility 'trial right' period, switching back to Original Medicare is easy. However, applying for a Medigap plan to go with it will likely require you to answer health questions. This is called medical underwriting. An insurance company can charge you a higher premium or deny your application for a Medigap policy based on your health status. This is why the initial decision at age 65 is so important, as your right to get a Medigap plan without health questions is strongest then.
Will my plan cover me if I travel outside of Ohio?
This is a major difference between the two options. A Medigap plan offers nationwide coverage. You can see any doctor or hospital in the U.S. that accepts Medicare. This is ideal for snowbirds or frequent travelers. Medicare Advantage plan coverage is typically regional. HMO plans generally only cover you outside your service area for emergencies or urgent care. PPO plans offer more flexibility and may have some coverage for out-of-network providers, but you will almost always pay more than you would for an in-network doctor.
Serving Elyria and nearby communities
We help Medicare-eligible residents across Elyria, Lorain, North Ridgeville, Avon, Carlisle Township, and the rest of Lorain County. Major hospital networks in this area include University Hospitals Elyria Medical Center, Mercy Health Lorain. When you fill out the callback form, a licensed Ohio agent will check which plans cover your specific doctors and prescriptions.
Get a free, no-pressure Medicare review
A licensed Ohio agent will reach out within 24 hours and walk you through the right plan for your doctors, prescriptions, and budget.
- A real, licensed local insurance agent — no call center
- No cost, no obligation, no robocalls
- Your information stays private and is never sold
Prefer to skip the form? Call (234) 380-6282 — United Medicare Club, our partner agency.
Let's start with your name
🔒 Your information is private and is only used to have a licensed agent help you. We never sell your data.