During the Medicare Annual Enrollment Period (Oct. 15 – Dec. 7), you can make changes to your existing coverage or enroll in a new plan. Any coverage changes go into effect Jan. 1.
Medicare Advantage (MA) plans are private health plans that offer coverages above and beyond what Original Medicare provides.
This checklist covers key factors to consider when exploring Medicare Advantage plans, so that you can make an informed enrollment decision for 2023. You can also speak to a licensed Medicare enrollment advisor who meets NCOA’s Standards of Excellence.
October 15 marks the start of the Medicare Annual Enrollment Period (AEP), which runs through Dec. 7. If you or a loved one is a Medicare beneficiary, or aging into Medicare, it’s time to make important decisions about health care coverage options for 2023. This includes deciding whether you want to enroll in a Medicare Advantage (MA) plan for the first time or make changes to your current plan.
What is Medicare Advantage?
Medicare Advantage, also referred to as Part C, is one of the four parts of Medicare:
- Medicare Part A – Hospital Insurance
- Medicare Part B – Medical Insurance
- Medicare Part C – Medicare Advantage (combines Parts A and B)
- Medicare Part D – Prescription Drug Coverage
Medicare Advantage plans are private health plans that have contracts with Medicare. If you decide to enroll in an MA plan, your Medicare-covered health care services go through the private plan.
To enroll in a Medicare Advantage plan, you must be enrolled in Original Medicare (Parts A & B). This is also true if you want to enroll in a Part D / Medicare drug plan.
What does Medicare Advantage cover? Why do I need it?
Original Medicare covers some of the costs of services, such as hospital and skilled nursing facility stays, home health, and hospice (Part A) and doctor visits, durable medical equipment, and labs (Part B). But it doesn’t pay for everything. While MA plans provide the same standard coverages as Original Medicare, they also offer extra benefits that can help you reach and maintain your health and wellness goals. These can include:
- Vision (eyewear), routine dental, and hearing aids
- Health club memberships
- Prescription drug coverage
Some Medicare Advantage plans even cover additional non-medical benefits such as nutrition counseling and meal delivery services. These plans are designed to promote an active lifestyle where you feel socially connected to others in your community.
How do I choose the best Medicare Advantage plan for me?
Choosing a Medicare Advantage plan isn’t a one-size-fits-all scenario. That’s why it’s smart to do your homework first. Use this checklist to help you understand the options available to you and make an informed decision about your health plan.
2023 Medicare Advantage Checklist
🔲 1. Are your favorite doctors, hospitals, and pharmacies in the plan’s network?
Medicare Advantage plans have their own lists of doctors who are in-network, so it’s important to check that your preferred doctors are listed.
🔲 2. Does your plan allow you to visit a non-network provider?
Some plans permit you to see out-of-network doctors, but you will likely pay more money out of pocket for these visits.
🔲 3. Are there prescription drugs you take regularly and does your plan cover them?
Medicare Advantage plans include Original Medicare benefits and often have prescription drug coverage (Part D) as well. Find out if the specific prescription drugs you take are included under the plan you’re considering and what you will have to pay for them. For example, some MA prescription drug plans offer certain medications with $0 copays (depending on their drug list and drug-tier levels).
Drug lists can change every year, so you’ll want to check annually whether your prescription medications are still covered under your plan and what you will have to pay for them.
🔲 4. Do you enjoy being active and exercising? Would a fitness benefit interest you?
In addition to extra benefits like dental, vision, and hearing, many MA plans offer fitness programs for older adults, such as SilverSneakers®. These programs can help you make physical activity part of your everyday life.
🔲 5. How much does your plan cost, and does it fit your budget?
Several factors determine Medicare Advantage out-of-pocket (OOP) costs, such as premiums, deductibles, copayments, and coinsurance. These costs may vary based on the plan you choose. Your costs also will be decided by how often you need medical services, and whether you see any specialists in addition to your primary care provider. MA plans have a yearly cap on how much you’ll pay out of pocket. For 2023, the out-of-pocket maximum for Medicare Part C plans is $8,300 (but some plans set lower limits).
🔲 6. Are there programs available to help you with Medicare out-of-pocket costs?
Medicare can help cover some medical- and health-related costs, but it's not free. If you need helping paying Medicare out-of-pocket costs, research income guidelines for available assistance programs and apply if you think you might qualify.
If you have special health care needs, you might consider a Medicare Special Needs Plan (SNP), which is a type of MA plan. Some people are eligible for both Medicare and Medicaid and can enroll in a Dual-Eligible SNP (D-SNP). Those who qualify are either older adults with low income or people living with a disability or end-stage renal disease.
🔲 7. Would non-traditional benefits, such as transportation and food delivery services, be helpful to you?
Some Medicare Advantage plans offer other non-medical benefits, such as:
- Help with utility costs
- Access to and assistance with buying healthy foods
- An allowance toward over-the-counter items
- Fall prevention aids
If these types of services would make your life easier, it may be a good idea to find MA plans that include them.
Medicare Advantage enrollment and next steps
There are many factors to consider when choosing a Medicare Advantage plan.
With a little research up front, you’ll be able to select the plan that’s a good fit for your medical needs, lifestyle, and budget.
Once you’ve identified the MA plan that meets your needs, it’s time to enroll and make your initial premium payment. Remember that there are limited periods during which you can enroll (and disenroll) from a private Medicare Advantage health plan. Avoid paying a late penalty fee by taking note of when the enrollment window is open.
Talk to a licensed advisor that meets our Standards of Excellence
Need assistance sorting through all your Medicare options? NCOA offers tools and resources to help you make a smart, informed decision about your coverage. Through our free Age Well Planner tool, you can get a personalized Medicare cost estimate, learn more about the different plans available to you, and find out when and how to enroll in the program.
If you decide you’d like more tailored, one-on-one advice, you can also connect with a licensed Medicare specialist. The brokers we work with are thoroughly trained and certified to meet NCOA’s exclusive Standards of Excellence. These standards help ensure our partners are highly knowledgeable in all things Medicare—and that they provide consumer-focused guidance that is impartial, practical, and 100% confidential.
This content was developed in partnership with Aetna. Learn more about what you need to know about Medicare.