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10 Things You Need to Know About Medicare Advantage

Debra Gordon

Last updated: November 22, 2016 3:16 pm

From now until December 7, it’s open enrollment for Medicare. That means you can switch from regular Medicare to Medicare Advantage (the managed care version of Medicare); switch from Medicare Advantage back to regular Medicare; or switch from one Medicare Advantage plan to another. Here are 10 things you need to know:

1. Keep paying part B.
You still have to pay the premium for Part B. Some Medicare Advantage plans also require an additional premium and, believe it or not, some pay part of your Part B premium. In 2015, the average premium for Medicare Advantage is expected to be about $33.90 a month.

2. Compare plans.
You can compare plans in your area at Medicare.gov/find-a-plan.

3. Check the provider list.
Unlike regular Medicare, where you can go to any provider that accepts Medicare, Medicare Advantage plans, which are run by private insurers, have limited networks. If you go out of network, you’ll pay more. You may also need referrals to see specialists and receive certain procedures and tests. So make sure your doctor is in the network of the plan you choose. Also keep in mind that providers can join or leave plans at any time during the year, and that the plan can change providers at any time.

4. Enjoy prescription drug coverage.
Most Medicare Advantage plans cover prescription drugs, so you don’t need a separate drug plan. However, check which drugs are covered and what copays are required.

5. Add up out-of-pocket costs.
You still have out-of-pocket expenses with Medicare Advantage, including premiums, deductibles, and copayments. However, in 2015, you won’t have to pay more than $6,700 out of pocket, although some plans have even lower out-of-pocket maximums.

6. Look for “extra” benefits.
Many Medicare Advantage plans may have coverage for vision, dental, and hearing services, which aren’t covered under the plain-vanilla Medicare program. Some even cover certain over-the-counter medications or pay a portion of a gym membership.

7. Cancel your Medigap policy.
You’re not allowed to have a Medigap, or supplemental, policy if you have Medicare Advantage.

8. Check the stars.
Medicare Advantage plans are ranked on a five-star system. Those with the most stars are the best in terms of member satisfaction and quality outcomes. Another advantage? You can switch into a five-star plan any time throughout the year (but only once).

9. Your rights are protected.
You have the same rights and protections under Medicare Advantage as you do under regular Medicare, including the right to appeal a denial for any service.

10. You can change your mind.
Made the wrong choice? Between January 1 and February 7, you can switch back to original Medicare.