10 Things to Know about Medicare Advantage

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

Nearly one-third of Medicare beneficiaries (over 19 million people) use Medicare Advantage. The types of plans offered by Medicare Advantage include HMOs, PPOs, SNPs, and PFFSs, so you have plenty of options available to you.

10 things to know about Part C

Here are 10 important things to know when considering a Medicare Advantage plan:

  1. Under Medicare Advantage, you pay a monthly premium in addition to your Part B premium.
  2. You can’t have Medicare Advantage and Medigap (Medicare supplement) at the same time.
  3. You cannot have Medicare Advantage with prescription drug coverage and a stand-alone Medicare Part D plan at the same time.
  4. If you have End-Stage Renal Disease (ESRD), you are not eligible for Medicare Advantage.
  5. Some plans offer vision, hearing, dental, and prescription drug coverage.
  6. Fitness memberships are included in some Medicare Advantage plans.
  7. Under a Medicare Advantage plan, you must use the doctors and hospitals that are in-network. (With PPOs, you can use out-of-network doctors, but you will usually pay more.)
  8. Unlike Original Medicare, Medicare Advantage plans have annual out-of-pocket limits.
  9. With Medicare Advantage, you still have Medicare and all the rights and protections that come with it.
  10. Plans and coverage can change. Be sure to do your research annually to assure your plan is still the best one for you. Also check the deductibles, star rating, and travel coverage to make sure your plan meets all of your needs.

If you are thinking of switching to Medicare Advantage, you can do so during the fall Open Enrollment Period from October 15 to December 7. If you are enrolling for the first time, you may do so during your Initial Enrollment Period: the three months before your 65th birthday, your birthday month, and the following three months. If you need to disenroll from a Medicare Advantage plan, you may do so during the Medicare Advantage Disenrollment Period, January 1 to February 14.