Is Medicare Advantage a Good Fit for You?

Since Medicare Advantage Open Enrollment is happening now (through March 31) you might be wondering if a Medicare Advantage plan is right for you.

If you chose a Medicare Advantage plan previously, this enrollment period allows you to do a few things. You can either stick with your current Advantage plan, change to a new Advantage plan, or quit Advantage altogether and return to Original Medicare. If you do return to Original Medicare, you can also enroll in a Part D (prescription) plan at this time. However, you can’t switch from Original Medicare to Medicare Advantage at this time. In order to do that, you’ll need to wait until the Annual Election Period in the fall, or qualify for a Special Enrollment Period.

So, what is the difference? Medicare Advantage plans are operated through a network of providers, organized by private health insurance companies, similar to other health insurance plans you might have used prior to retirement. By contrast, Original Medicare is of course run by the government, and the plan is standard throughout the country. You can receive care anywhere that accepts Medicare.

All Medicare Advantage plans must conform to basic standards set forth by Medicare. Many, but not all, Medicare Advantage plans also include Part D coverage, so that your prescriptions are covered by the plan.

Medicare Advantage plans roll Medicare Parts A and B into one plan, for one premium. Your plan will charge co-payments, which vary according to each plan, and your plan will also have a cap on out-of-pocket spending. Original Medicare charges a 20 percent co-payment on all Part B services, and you’re subject to a deductible on both Part A and Part B. Part of your decision between Original Medicare and Medicare Advantage will involve comparing these potential costs.

Because Medicare Advantage plans can vary, another one might suit you better if you feel dissatisfied with your current network, formulary of covered prescriptions, or some other aspect of the plan. Perhaps you just want to investigate whether another Advantage plan would provide more accessibility to your needs.