Thinking about Medicare Advantage? — The Elfand Group

The Elfand Group · Medicare Advantage

Thinking about Medicare Advantage?

Let’s keep this simple. Tell us where you are today, and we’ll show you just what matters for your situation — no jargon, nothing to sign up for.

Start here

Which describes you today?

Pick one and we’ll tailor the rest of the page to you.

Good news — you’re not on the clock

If you’re already on Advantage, you don’t have to shop in the fall rush.

Because you’re already enrolled, you get a second window — January 1 through March 31 — to switch to a different Advantage plan or move back to Original Medicare (one change). So there’s usually no need to rush during Open Enrollment.

The one exception: if your plan sends a notice that it’s ending or leaving your area next year, act during Open Enrollment (October 15 – December 7). Otherwise, we’d rather review it with you calmly — and help you pick the right time.

When you do review it, look at these

Your plan can change every January. A few minutes now can save a surprise later.

Did you get an “ANOC” or non-renewal letter?
Each fall your plan mails an Annual Notice of Change. If it says your plan is ending, you’ll need to pick a new one during Open Enrollment.

Are your doctors and hospital still in-network next year?
Networks change — and can change mid-year, too. Make sure the people you see are still covered.

Are your prescriptions still covered, at a good price?
Drug lists and pharmacy costs shift every year.

Did your copays, out-of-pocket max, or extras change?
In 2027, no plan can charge you more than $9,850 in-network for covered care — but plans differ a lot below that.

Thinking about leaving Advantage to go back to Original Medicare + a Supplement? There’s an important catch — getting a Supplement back can require passing medical underwriting unless you’re inside a 12-month “trial right.” See how Medigap switching works → — and talk to us first.

Want us to review your plan with you — at the right time?

Leave your details and we’ll compare your current plan against the others in your area, using your doctors and prescriptions. If there’s no rush, we’ll reach out when it makes the most sense. Free, no obligation — nothing changes on your current coverage.

Start with the honest question

First — is Advantage even right for you?

The real question isn’t which Advantage plan — it’s whether Advantage fits how you like to get your care. Take this quick check, then read the honest picture below.

Private by design: this runs on your own screen. Nothing is saved or sent unless you choose to share your details later. Joining Advantage needs no health questions — this is about fit, not approval.

The one thing to understand first

Medicare Advantage replaces Original Medicare with a private plan.

It can lower your monthly cost and add extras like dental and vision — but you trade any-doctor freedom for a network, and you give up your Supplement. Getting that Supplement back later usually means passing medical underwriting — unless you act inside a 12-month “trial right.”

How Medicare Advantage works

In plain English.

It’s still Medicare, run by a private company. You keep Parts A & B and still pay your Part B premium; the plan is on top of that.

All-in-one. Most plans bundle your Part D drugs plus extras — dental, vision, hearing, an OTC allowance, a gym benefit.

What you pay. Often a low or $0 plan premium (you still pay Part B), then copays as you go, up to a yearly in-network cap — no more than $9,850 in 2027; drugs have their own $2,400 cap.

The parts people wish they’d known

The trade-offs behind that lower price

None of these are deal-breakers — but you should know them before you switch.

Networks can change at any time.
The plan’s network isn’t locked for the year. A doctor or hospital can leave — or be dropped — mid-year, so the plan you pick in December might not include your doctor in June. With Original Medicare, any provider nationwide that takes Medicare works.

Prior authorization & preapprovals.
For many services — imaging, surgeries, skilled nursing, some specialists — the plan must approve the care before it’s covered. Approvals can be delayed or denied, and you may have to appeal. Original Medicare rarely requires this.

Referrals (on HMO plans).
You may need your primary doctor’s referral before you can see a specialist.

Out-of-network can cost you.
On many plans (especially HMOs), care outside the network isn’t covered except in an emergency — so where you get care matters.

Advantage vs. what you have now

Neither is “better” — they’re built for different priorities.

Medicare Advantage

Lower monthly cost (often $0 plan premium)
Pay copays as you go, up to a yearly cap
Network of doctors; referrals & prior approval common
Best if you mostly stay local
Bundles drugs + dental / vision / hearing / gym

Original Medicare + Supplement

Higher monthly cost (the Supplement premium)
Very predictable — little or nothing when you use care
Any doctor nationwide that takes Medicare
No networks, referrals, or prior approvals
Drugs are a separate Part D plan; extras not included

What a typical PPO actually looks like

They really do all look about the same. Here’s a made-up plan with numbers typical of a $0-premium PPO — so you can see the good, the bad, and the ugly in one place.

Sample plan · illustration only

Cornerstone Signature (PPO)

$0 monthly plan premium · covers medical + drugs

Monthly plan premium	$0 — plus about $40/mo back on your Part B
In-network deductible (medical)	$0
Primary care visit	$0
Specialist visit	$50
Urgent care / emergency room	$40 / $115
Hospital stay (in-network)	about $395/day, days 1–7, then $0
Lab / X-ray / CT & MRI	$0 / $50 / $350
In-network out-of-pocket max	about $8,900 ($13,900 with out-of-network)
Out-of-network care	about 40% after a separate $950 deductible
Extras included	Dental ~$500/yr, eyewear $100, hearing aids ~$500/ear, OTC $30/quarter, gym (SilverSneakers)
Referrals to see a specialist	Not required (it’s a PPO)
Prior authorization	Required for many services (hospital, imaging, more)

The good

$0 premium (and about $40/mo back on Part B), $0 primary-care visits, and dental, vision, hearing, OTC and a gym rolled in. Being a PPO, you can go out-of-network.

The bad

Copays add up if you use a lot of care ($50 a specialist, $395/day in the hospital). The extra allowances are modest — $500 dental, $100 eyewear don’t go far. Out-of-network runs ~40% plus its own deductible.

The ugly

Prior authorization on hospital stays, imaging and more — approvals can be delayed or denied. The ~$8,900 max means a rough year can still cost thousands. And the network can change mid-year. “$0 premium” is not “free.”

This is an illustration, not a real plan — real plans vary by county and change every year. The point is the shape, not the exact numbers. We’ll pull the real ones for your ZIP.

Before you drop your Supplement to try Advantage

Getting your Supplement back isn’t guaranteed

If you leave Original Medicare + Medigap for Advantage, you can usually only get a guaranteed Supplement back (no health questions) by using a “trial right”:

First time ever on Advantage? You have 12 months to change your mind, drop it, and buy a Supplement guaranteed-issue.
Outside that window, switching back usually means medical underwriting — if your health has changed, you could pay more or be turned down.
The timing is strict (about 60 days before through 63 days after your Advantage coverage ends), and it’s tied to your first time on Advantage.

This isn’t a reason to avoid Advantage — it’s a reason to go in with your eyes open, and time it with someone who does this every day. That’s us.

Want us to run the real comparison — free?

The only way to know for sure is to compare the actual plans in your ZIP against your doctors and prescriptions. Leave your details and we’ll do exactly that with you. No obligation, and nothing changes on your current coverage until you decide.

Reviewing your other pieces too?

Review your Part D drug plan →

Thinking about your Medicare Supplement (Medigap)? →

Prefer a neutral source? Medicare’s own help line, 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), is free and open 24/7, and your state’s SHIP counselors give free, one-on-one help with no sales.

The Elfand Group · Educational information only, not medical or insurance advice · Not connected with or endorsed by the U.S. government or the federal Medicare program · We do not offer every plan available in your area; any information we provide is limited to the plans we do offer — please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.