What are the advantages and disadvantages of Medicare Advantage plans?

What is Medicare Advantage?

Medicare Advantage plans (Part C) can offer you more than you would get with Original Medicare. Learn about your plan options and take the time to think about your budget and coverage needs to see which option is best for you.

The advantages of a Medicare Advantage plan

Most Medicare Advantage plans include benefits you might need that aren’t covered by Original Medicare, like:

• Routine dental care, including x-rays, exams, and dentures.
• Vision care, including glasses and contact lenses.
• Hearing services, including hearing tests and devices.
• Coverage for prescription drugs.
• Fitness and wellness programs, including SilverSneakers.

Many Medicare Advantage plans have low premiums (sometimes as low as $0). Medicare Advantage plans may also have a limit on your maximum out-of-pocket costs for Part C-covered services. Once you reach the limit, you pay nothing for the rest of the year. Try to compare the costs of Medicare Advantage plans along with the coverage.

How will Medicare Advantage be purchased with 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 medical care, such as doctor visits, medical tests, screenings, and preventive care services. If you need more coverage, Medicare Advantage plans include Medicare Part A and Part B coverage, plus additional benefits.

Learn more 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 choices when it comes to doctors and hospitals because they may have smaller plan networks than Original Medicare. And if you join 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 won’t be able to use your Medicare Advantage benefits with an employer health plan.

Questions to ask when comparing Medicare Advantage plans

Looking for the best Medicare Advantage plan can be worth the extra coverage. Be sure to ask the right questions to get the most out of the plan you choose.

• Are your preferred hospitals or doctors included in the Medicare Advantage plan?
• The doctors and hospitals in a plan’s network can change every year, so it’s best to make sure your PCP stays with the plan after your initial enrollment. Ask when you go to a medical consultation.
• What prescription drugs are covered?
• You can use our Find Medications tool to see which ones are included in the plan. If you need medications, are they included in the selected plan and are they offered at a low price?
• What is the maximum out-of-pocket amount?
• You may prefer a lower out-of-pocket maximum to cover unexpected illness or injury.

Medicare Advantage and the CARES Act

The Coronavirus Aid, Relief, and Economic Security (CARES) Act has some benefits for Medicare Advantage plans. Federally licensed health centers and rural health clinics must offer telemedicine 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 medications without restrictions.

How do you join a Medicare Advantage plan?

You can take advantage of the annual enrollment period (October 15 to December 7) to join a Medicare Advantage plan for the first time if you currently have Original Medicare.

How do you change your Medicare Advantage plan?

If you choose a Medicare Advantage plan that doesn’t offer the coverage you need or if the cost becomes too high, you have the option to switch to other plans once a year during the Medicare Advantage open enrollment period. During this period, you can change or drop an existing Medicare Advantage plan.