Medicare Advantage plans, also called Medicare Part C, are private insurance plans approved by Medicare that provide your Part A and Part B benefits. Most of these plans offer coverage for things original Medicare doesn't pay for, like vision, hearing, dental, and fitness benefits.

In this article, we’ll explore some questions to keep in mind when making a choice about how to receive your Medicare coverage, and whether a Medicare Advantage Plan is right for you.

“A low monthly premium and extra benefits can make a Medicare Advantage plan seem appealing, but they really don’t tell the whole story,” said Medicare expert Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits. “Before enrolling, make sure the plan covers your preferred doctors and prescriptions and that you know what kinds of costs you’ll be responsible for throughout the year.”

Before choosing a Medicare Advantage plan, check that it covers your doctors, prescriptions, and preferred pharmacy. Be sure you also understand the total costs, coverage rules, and any extra benefits provided by the plan.

Providers, hospitals, and other facilities

Medicare Advantage plans often use provider networks. Check whether the doctors, specialists, hospitals, and other facilities you use (or may need) participate in the plan.

✅ Questions you should ask:

• Will I be able to use my doctors? Are they in the plan’s network?
• Do doctors and providers I want to see in the future take new patients who have this plan?
• If my providers aren’t in-network, will the plan still cover my visits?
• Which specialists, hospitals, home health agencies, and skilled nursing facilities are in the plan’s network?

Access to health care

A Medicare Advantage plan’s service area and coverage rules can affect where and how you receive care. Find out if you’ll need referrals, prior authorization, or a designated primary care provider (PCP).

✅ Questions you should ask:

• What is the service area for the plan?
• Do I have any coverage for care received outside the service area?
• Who can I choose as my primary care provider?
• Does my doctor need to get approval from the plan to order tests or admit me to a hospital?
• Do I need a referral from my PCP to see a specialist?

Benefits

Many Medicare Advantage plans offer benefits original Medicare doesn’t cover, such as fitness club memberships and transportation. Find out exactly what each benefit includes and if any limits or restrictions apply.

✅ Questions you should ask:

• Does the plan cover any services original Medicare does not?
  • Dental services
  • Vision care
  • Hearing aids
  • Other benefits like eyeglasses, transportation to doctor appointments, and debit cards used to pay for extra expenses
• Are there any rules or restrictions I should be aware of when accessing these benefits?

Costs

Look beyond the monthly premium when you’re comparing different plans. Deductibles, copays, coinsurance, and out-of-network charges can significantly affect how much you spend during the year.

✅ Questions you should ask:

• What costs should I expect for my coverage (premiums, deductibles, copayments)?
• What is the annual maximum out-of-pocket (MOOP) cost?
• How much will I have to pay out of pocket before coverage starts (what is the deductible)?
• How much is my copayment for services I regularly receive, such as PCP or specialist care?
• How much will I pay if I visit an out-of-network provider or facility?
• Are there higher copays for certain types of care, such as hospital stays or home health care? Can I afford the copays if I need the care over a long time period?

Prescription drugs

Most Medicare Advantage plans include prescription drug coverage, but formularies, pharmacy networks, restrictions, and costs vary. Make sure the plan covers the prescription medications you take regularly and provides convenient ways to fill them.

✅ Questions you should ask:

• Does the plan cover outpatient prescription drugs?
• Are my prescriptions on the plan’s formulary?
• Does the plan impose any coverage restrictions?
• What costs should I expect to pay for my drug coverage (premiums, deductibles, copayments)?
• How much will I have to pay for brand name drugs? How much for generic drugs?
• How do I sign up for the Medicare Prescription Payment Plan through my plan?
• Will I be able to use my pharmacy? Can I get my drugs through mail order?
• Will the plan cover my prescriptions when I travel?

Coordination of benefits

Before joining a plan, learn how it will work with any other insurance you have. Changing coverage could affect your employer or retiree benefits and your ability to keep Medigap coverage or get it later down the road.

✅ Questions you should ask:

• How does the plan work with my current coverage?
• If I join, would I lose my job-based insurance or retiree coverage?
• Will I lose my Medigap policy if I join?

Who can help me choose the best Medicare plan?

Reach out to your local State Health Insurance Assistance Program (SHIP) for personal guidance on selecting a Medicare plan.

SHIP counselors are highly knowledgeable about Medicare. They will:

• Help you compare plans to find coverage that fits your budget
• Offer honest, unbiased guidance based on your personal needs
• Help you avoid penalties and understand enrollment timelines
• Explain cost-saving programs like Part D LIS/Extra Help or the Medicare Savings Programs (MSPs) and how to apply

Visit the SHIP website and click on the orange "SHIP Locator" button to get started.