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.

Top 5 Medicare Mistakes to Avoid

Medicare mistakes are common due to the complex nature of Medicare, the national healthcare system for people over 65 and some disabled people. Here are five costly Medicare mistakes to avoid.

1.      Not enrolling when you first become eligible

Most people will automatically be enrolled in Medicare Part A when they turn 65. If you are not already receiving Social Security benefits, you will need to enroll in Medicare Part B during your Initial Enrollment Period. This is the three months before your 65th birthday, your birthday month, and the following three months. If you don’t enroll when you first become eligible, you could face late enrollment penalties later on.

2.      Failing to read your Annual Notice of Change

This document arrives in the mail each September and notifies you of any changes to your current Medicare Advantage or Medicare Part D plans, like increasing premiums, deductibles, or changes in covered services. It’s important to read this document in case you need to change plans during the Open Enrollment Period. Failing to do so could mean you’re stuck with an expensive plan that doesn’t give you the coverage you need in the following year.

3.      Assuming Medicare will cover everything

While Medicare will probably cover most of your healthcare expenses once you turn 65, it doesn’t cover everything. For example, Medicare doesn’t cover deductibles, premiums, copays, or coinsurance. If you have a chronic illness or expect recurring doctor visits, this could mean you’re paying a lot out-of-pocket. Thankfully, Medigap exists to help you cover some of the out-of-pocket costs of Medicare.

4.      Not picking the right Medigap plan

Medigap currently offers 10 plans (standard in most states) to help you save on out-of-pocket Medicare costs, so knowing which one is right for you can be tricky. Do you choose the one with the most coverage with higher premiums? Or one with fewer coverage options and lower premiums? Consider consulting your local State Health Insurance Assistance Program (SHIP) to help you decide.

5.      Not doing your research for Medicare Advantage

Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), which most Medicare beneficiaries have. Original Medicare doesn’t cover services like dental, vision, and hearing care. However, many Medicare Advantage (Medicare Part C) plans do cover these services. If you know you’ll want coverage of these services, it would be wise to research your Medicare Advantage options before enrolling in Medicare coverage.

Additional Medicare resources:

·         Visit www.Medicare.gov

·         Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, 7 days a week

·         Call your local State Health Insurance Assistance Program (SHIP) to see if you qualify for any financial assistance.

Medigap vs. Medicare Advantage: Which is Better?

Most people are aware of Original Medicare (Part A and Part B), but there can be some confusion when it comes to supplemental and alternative plans. 

What are Medigap and Medicare Advantage plans?

Medicare Advantage plans are  healthcare plans sold by private insurance companies. By law, the plan must offer the same benefits as Original Medicare, but the plans often come with extra benefits like dental, vision, hearing, and prescription drug coverage. 

Medicare supplement (Medigap) plans fill the “gaps” in your Original Medicare coverage. This means a plan will often pick up the bill for out-of-pocket expenses like copays, deductibles, and coinsurance and is also sold by private insurance providers. 


There are several different types of cost associated with Medicare:

  1. Premiums. Medigap premiums typically range between $100 and $250 per month. Medicare Advantage premiums can be anywhere from $0 to over $300. 
  2. Copays. Medigap plans pick up copays you accrue from Original Medicare. You are subject to copays with Medicare Advantage.  
  3. Deductibles. Medicare Advantage deductibles vary by plan; some are $0. Medigap plans do not cover the Medicare Part B deductible unless you purchased Plan F or Plan C before December 31, 2019 before these plans were phased out. 
  4. Out-of-pocket costs. Medigap plans pick up the bill for out-of-pocket costs; you typically will not have any out-of-pocket costs with Medigap unless your healthcare is not covered by Original Medicare. Out-of-pocket costs vary by Medicare Advantage plan, but no plan can have a cap higher than $6,350 in 2020.


Medicare Advantage plans vary by county. If you live in a rural area, you may have fewer options for Medicare Advantage plans. 

Medigap has 10 standardized plans across the United States, with the exception of Minnesota, Massachusetts, and Wisconsin, which have their own standard plans. Medicare announced in 2019 that it was phasing out its most popular plans–F and C. However, this is just for newly-eligible beneficiaries; everyone born before December 31, 2019 may purchase Medigap Plan F and Plan C indefinitely. 


You do not need a referral to see a specialist if you have Original Medicare with a Medigap plan. 

You may need a referral to see a specialist if you have an HMO Medicare Advantage plan; many PPO plans do not require a referral. 


Ninety-nine percent of doctors, hospitals, and clinics in the United States accept Original Medicare. If you have Original Medicare with a Medigap plan, you may see any of these doctors. Medigap plans are beneficial to snowbirds who split their time between states or for beneficiaries who travel often. 

Beneficiaries with Medicare Advantage plans may be subject to smaller networks of doctors and could be the victim of surprise medical bills. 

Note: It is wise to call your insurance before a non-emergency appointment to verify that the doctor, hospital, or clinic is in your network.

Enrollment periods

It’s best to enroll in a Medigap plan during your initial enrollment period, or when you are first eligible for Medicare. 

You can enroll in a Medicare Advantage plan or switch plans each year between January 1 and March 31. 

If you have a Medigap plan with Original Medicare, you will also need to purchase a Medicare Part D prescription drug plan.

Many Medicare Advantage plans come with prescription drug coverage included. 

Additional notes

  • Medical underwriting. If you wait to purchase a Medigap plan or switch from one plan to another, you could be subject to medical underwriting. Medical underwriting is when an insurer can limit your coverage, deny your coverage, subject you to a waiting period, or charge you much higher rates. 
  • Must choose one or the other. You may not have a Medigap and a Medicare Advantage plan at the same time. It is illegal for a Medicare broker to sell you one plan while you have the other. 

If you’re having trouble choosing between Medicare Advantage plans and Medigap plans, you can call your local State Health Insurance Assistance Program (SHIP) for free and unbiased advice about your Medicare options.

5 Tips for Picking a Medicare Advantage Plan

With all the choices out there, it’s important to find out the best ways to pick out a Medicare Advantage plan. Medicare Advantage plans are an alternative to Original Medicare in that sometimes include other benefits like prescription drugs, dental, vision, and fitness benefits.

With Medicare Advantage plans, you sometimes have lower premiums and there is an annual out of pocket limit on how much you can spend each year. This amount varies with each plan, but cannot be more than $6,700. Also with Medicare Advantage, there is a network of providers that you have to stick with, and you don’t have as much freedom to visit any doctor in the country like you do with Original Medicare.

5 Tips for Choosing a Medicare Advantage Plan

Here are 5 tips to follow when choosing a Medicare Advantage plan:

  1. Don’t choose based on what benefits the plan offers. The main things to look at are whether the plan covers the doctors and the prescription drugs that you need. You might really want a plan that gives you membership to a fitness club, but make sure to look at the medical essentials first so you’re not caught in a bind.
  2. If you already have a Medicare Advantage plan, check your Annual Notice of Change (ANOC). Your plan should send you this ANOC in the fall to let you know if anything is changing in your plan. Check it carefully (any major changes should be listed on the first few pages) so that you can make sure your needs are still covered. If anything major with drug or doctor coverage is changing, you should look at other plans that might be better for you.
  3. If you choose to go with Medicare Advantage, it is safe to have some other funds set aside for possible medical emergencies, since out of pocket costs can go up to $6,700 with these plans. If you don’t have extra medical savings, a Medigap plan with full coverage will be a good option for you. (Note: you can’t have a Medigap plan and a Medicare Advantage plan at the same time.)
  4. There’s no one-size-fits-all Medicare Advantage plan that’s going to be great for everyone. Look around and see what options are best for you and your situation, especially regarding the doctors in the plan’s network.
  5. Check the Medicare Advantage plan’s star rating. Medicare gives each plan a star rating from 1 to 5. It’s best to choose a plan with a 3.5 or higher star rating. Plans with a 4 or 5 star rating receive extra funding from the government for your medical benefits.