Medicare Advantage plans can look attractive. Some plans have low additional monthly premiums, and some can include extra benefits.
But the monthly premium is only one part of the story.
Before you enroll, it’s important to understand how the plan works when you actually need medical care.
At Senior Savings Network, we help you compare your Medicare options so you can make an informed decision based on your doctors, prescriptions, healthcare needs, budget, and priorities.
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Medicare Advantage, also called Medicare Part C, is an alternative way to receive your Medicare benefits.
Instead of receiving your Part A and Part B benefits directly through Original Medicare, you enroll in a Medicare Advantage plan offered by a private insurance company approved by Medicare.
Many Medicare Advantage plans also include Part D prescription drug coverage and additional benefits not provided by Original Medicare.
That can sound appealing—and for some people, Medicare Advantage may be a good fit.
The important question is:
What are you giving up in exchange for those benefits?
Medicare Advantage plans often focus on extra benefits rather than core medical coverage
Those benefits may be valuable.
But they shouldn't be the only reason you choose a healthcare plan.
Your Medicare coverage needs to work when you are sick, need a specialist, have surgery, require rehabilitation, or receive other expensive medical care.
That’s why we encourage you to look at the entire plan—not just the benefits highlighted in an advertisement.
Most Medicare Advantage plans use a network of doctors, hospitals, specialists, and other healthcare providers.
Depending on the type of plan, receiving care outside that network may cost more or may not be covered except in certain situations.
Before enrolling, check:
And remember: provider networks can change.
A low monthly premium does not necessarily mean low healthcare costs.
Medicare Advantage plans can have copayments or coinsurance for services such as:
Every plan is different.
Instead of asking only, “What is the premium?” ask:
“What could this plan cost me if I have a bad health year?”
Some Medicare Advantage plans require prior authorization before certain services, procedures, tests, medications, or treatments are covered.
That means your healthcare provider may need approval from the insurance plan before you receive the service.
Prior authorization doesn't automatically make a plan a poor choice, but it is an important part of understanding how your coverage works.
When comparing plans, ask which services require approval and how that could affect your care.
If you spend part of the year in another state or travel frequently, pay close attention to the plan's rules for receiving care away from home.
Emergency and urgently needed care have specific protections, but routine and non-emergency care can depend on the plan and its network.
If access to doctors throughout the country is important to you, make sure you understand the difference between Medicare Advantage and Original Medicare with a Medicare Supplement before enrolling.
Medicare Advantage plans operate on an annual basis.
Premiums, copayments, provider networks, drug formularies, benefits, and other plan details may change from one year to the next.
That's why reviewing your coverage regularly is important.
A plan that works well for you this year may not necessarily be your best option next year.
These are two very different ways to manage your healthcare costs with Medicare.
Depending on the plan, you may have:
Depending on the Medicare Supplement plan you choose, you may have:
There isn't one answer that is right for everyone.
For some people, the lower monthly premium and additional benefits available with a Medicare Advantage plan can be attractive.
For others, predictable medical expenses and broader provider access available with Original Medicare and a Medicare Supplement may be more important.
The right decision depends on factors including:
This is why comparing more than the monthly premium matters.
You don't necessarily have to stay with the same plan forever.
There are specific Medicare enrollment periods and, in some circumstances, Special Enrollment Periods that may allow you to change Medicare Advantage plans or return to Original Medicare.
However, there is an important distinction:
Leaving Medicare Advantage does not always guarantee that you can purchase the Medicare Supplement policy you want.
Outside certain protected enrollment situations, you may have to answer health questions and qualify medically for a Medicare Supplement policy, depending on your circumstances and state rules.
If you're thinking about leaving Medicare Advantage, don't cancel your current coverage before understanding your options.
We can help you review the process first.
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You shouldn't have to make a Medicare decision based on a television commercial, a postcard, or a long list of benefits without understanding the fine print.
We'll help you look at the bigger picture.
Our experienced Medicare team can help you review available plans we offer in your area, compare costs and benefits, and understand how the coverage may work for your particular situation.
Click below to request Medicare help.
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