Choosing the Right Medicare Advantage Plan: What to Know Before You Enroll
Ask Questions, Enroll Today
Choosing the Right Medicare Advantage Plan: What to Know Before You Enroll
Medicare Advantage (also known as Medicare Part C) is an alternative way to receive your Medicare benefits through private insurance companies that are approved by Medicare. These plans combine Part A (hospital insurance) and Part B (medical insurance), and most also include Part D (prescription drug coverage). Some plans may offer additional benefits, such as dental, vision, or hearing services. Because plan options vary, it is important to carefully review and compare them before enrolling.
Key Factors to Consider:
Every year, Medicare Advantage Plans can change. This may include changes in costs, coverage, and the doctors or hospitals in the plan’s network. That is why it’s important to review your options for 2025 before you enroll. By comparing plans, you can make sure the coverage fits your health needs, prescription medications, and budget.
1. Coverage and Benefits
Not all Medicare Advantage plans cover the same services. While they all provide at least the same benefits as Original Medicare, plans may include extra benefits. Review what is included in each plan and make sure it aligns with your health needs.
2. Provider Networks
Many Medicare Advantage plans use provider networks, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Check whether your doctors, specialists, and preferred hospitals are included in the network, and confirm what happens if you need care outside of the network.
3. Prescription Drug Coverage
If you take prescription medications, review each plan’s formulary (list of covered drugs). Ensure your medications are covered and take note of copayments, prior authorization rules, or tiered pricing that may apply.
4. Costs
Medicare Advantage plans can have different out-of-pocket costs. Consider the following:
Monthly plan premiums (in addition to your Part B premium)
Annual deductibles
Copayments or coinsurance for services
The plan’s maximum out-of-pocket limit, which is the most you will pay for covered services each year
5. Plan Ratings
Medicare assigns star ratings (from 1 to 5) to Medicare Advantage plans based on quality and performance measures. Reviewing these ratings may help you understand how well a plan is serving its members.
Enrollment Periods
You can enroll in a Medicare Advantage plan during:
Initial Enrollment Period – When you first become eligible for Medicare.
Annual Enrollment Period (October 15 – December 7) – When you can join, switch, or drop a plan.
Open Enrollment Period (January 1 – March 31) – When you can make a one-time switch to another Medicare Advantage plan or return to Original Medicare.
Where to Find Help
Before enrolling, it may be helpful to use the Medicare Plan Finder tool on Medicare.gov to compare options available in your area. You can also contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased counseling.
