10 Things to Know About Medicare Advantage

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10 Things to Know about Medicare Advantage

Medicare Advantage, or Medicare Part C, is an alternative to Original Medicare that offers Part A, B, and sometimes Part D coverage through a private insurance company. Plans vary by state and by county, so check what’s offered in your area.

Medicare Advantage programs are becoming more popular, with nearly one-third, or over 19 million, of the Medicare population using Medicare Advantage. The types of plans under Medicare Advantage include HMOs, PPOs, SNPs, and PFFSs. Under Medicare Advantage, you pay your monthly Part B premium, plus usually a monthly premium to your Medicare Advantage plan as well.

With all of the options available to you, here are 10 important things to know when considering Medicare Advantage:

  1. A Medicare Advantage plan is an alternative to Original Medicare that is administered through a private insurance company approved by Medicare.
  2. You can’t have Medicare Advantage and Medigap supplement at the same time.
  3. You are not allowed to have Medicare Advantage that includes prescription drug coverage and Medicare Part D at the same time.
  4. If you have End-Stage Renal Disease (ESRD), you are not eligible for Medicare Advantage.
  5. Medicare Advantage plans differ by county, and some, but not all, offer vision, hearing, dental, and prescription drug coverage.
  6. Some plans include fitness club memberships.
  7. Under a Medicare Advantage plan, you must use the doctors and hospitals that are in your particular Medicare Advantage plan’s network. (With PPOs, you can use doctors outside the network, but you will usually pay more.)
  8. Unlike Original Medicare, Medicare Advantage plans include a limit on how much you will have to spend out of pocket each year.
  9. With Medicare Advantage, you still have Medicare and all the rights and protections that come with it.
  10. Plans and their coverage can change – be sure to double check each year for your plan’s copays and specific coverage. Also check the deductibles, star rating, and travel coverage to make sure your plan meets all of your needs.

Make sure you fully understand your policy before choosing it. Your favorite doctor might not be available under your new Medicare Advantage plan.

If you are looking to switch to Medicare Advantage, you can do so during the open enrollment period from October 15 to December 7. If you are enrolling for the first time, you may enroll the 3 months before, the month of your birthday, or the 3 months after the date you turn 65. If you need to disenroll from an MA plan, the period is January 1 to February 14.

Related Links

Everything You Need to Know about Medicare Advantage

Understanding Medicare Advantage

Video: Medicare Advantage vs. Medigap

Choosing a Medicare Advantage Plan

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Medicare World Editorial Team
The Medicare World editorial team works diligently to make sure our stories are informative, unbiased, and of utmost relevance to our readers. Our team of researchers and writers presents the best and latest information on all things Medicare, including legislation, enrollment rules, changes in coverage and costs, and health information. We enjoy keeping our readers up-to-date and helping them navigate the often-complicated Medicare maze.

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