What Medicare Advantage is
Medicare Advantage is an alternative way to receive Medicare benefits through a private plan. Plans must cover at least the same Part A and Part B services as Original Medicare (except hospice, which Original Medicare still covers), and many include Part D plus extra benefits such as dental, vision, or hearing.
Tradeoffs to understand
Plans typically use HMO or PPO networks, copays, prior authorization, and a yearly maximum out-of-pocket for in-network Part A and B services. Extra benefits can be valuable, but they vary by plan and area and can change each year. Travel outside the service area may be more limited than with Original Medicare plus Medigap.
Questions worth asking
Are your doctors and hospitals in-network? Are your medications on the formulary at a cost you can manage? What is the maximum out-of-pocket? How does the plan handle referrals and prior authorization? Do you travel? Have you read this year’s Annual Notice of Change?
When you can join or switch
Most plan changes happen during the Annual Enrollment Period (October 15 – December 7), with coverage starting January 1. If you are in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (January 1 – March 31) may also apply. Other Special Enrollment Periods can apply in specific situations.