What are the advantages and disadvantages of Medicare Advantage plans?
Medicare Advantage (Part C) plans can offer you more than you would have with Original Medicare. Explore plan options and take time to consider your budget and your coverage needs to see what works best for you.
The advantages of a Medicare Advantage plan
Most Medicare Advantage plans include benefits you may need that are not covered by Original Medicare, including:
- Routine dental care, including X-rays, exams, and dentures.
- Vision care, including glasses and contacts.
- Hearing care, including testing and hearing aids.
- Prescription drug coverage.
- Wellness programs and fitness center membership, including SilverSneakers®.
Many Medicare Advantage plans feature low premiums (sometimes $0). Medicare Advantage plans also cap your maximum out-of-pocket expenses for Part C covered services. Once you reach the cap, you pay nothing for the rest of the year. Be sure to compare the Medicare Advantage plans’ costs along with coverage.
How does Medicare Advantage compare to Original Medicare?
Original Medicare includes Part A and Part B. Part A covers hospitalization, home care, and other inpatient medical needs. Part B covers outpatient care, such as doctor visits, medical tests, screenings, and preventive care. If you need more coverage, Medicare Advantage plans include Medicare Part A and Part B coverage, plus additional benefits.
More to know about a Medicare Advantage plan
You still have to pay your Medicare Part B premium along with your Medicare Advantage plan premium.
Some Medicare Advantage plans may offer fewer options when it comes to doctors and hospitals, as they may have smaller plan networks than Original Medicare. And if you sign up for a Medicare Advantage plan with an HMO network, you may need a referral from your primary care doctor to see a specialist. If you’re still working, you may not be able to use your Medicare Advantage benefits with an employer health plan.
Questions to ask while comparing Medicare Advantage plans
Finding the best Medicare Advantage plan may be worth it for the extra coverage. Be sure to ask the right questions to get the most out of the plan you pick.
- Are your preferred hospitals or preferred doctors included in the Medicare Advantage plan?
Doctors and hospitals in a plan’s network can change yearly, so it’s best to make sure your family doctor is still in the plan after your initial enrollment. Just ask when you go for a doctor visit.
- Which prescription drugs are covered?
You can use our find a drug tool to see what drugs are available in the plan. If you need medications, are they available and affordable under a selected plan?
- What is the maximum out-of-pocket amount?
A lower out-of-pocket maximum may be preferable, so you have coverage for unexpected injuries or illnesses.
Medicare Advantage and the CARES Act
The Coronavirus Aid, Relief, and Economic Security (CARES) Act has some benefits for Medicare Advantage plans. Federally Qualified Health Centers and Rural Health Clinics must provide telehealth services to people with Medicare. The CARES Act also requires all Medicare Advantage prescription drug plans to allow members to obtain a 90-day supply of covered drugs without restrictions.
How do you sign up for a Medicare Advantage plan?
You can use the Annual Enrollment Period (October 15 – December 7) to sign up for a Medicare Advantage plan for the first time if you currently have Original Medicare.
How do you change your Medicare Advantage plan?
If you chose a Medicare Advantage plan that doesn't provide the coverage you need or if the cost becomes too expensive, you have the option to change to other plans once a year during the Medicare Advantage Open Enrollment Period. During this time, you can change or drop an existing Medicare Advantage plan.
