3 Medicare Advantage enrollment tips

You’re probably wondering whether to go with Original Medicare or a Medicare Advantage plan. While it’s ultimately up to you, Medicare Advantage plans can be a great choice for many people, including you.

The plans combine Medicare Parts A (hospital insurance) and B (medical insurance), as well as additional coverage. This all-in-one option is popular — more than 28 million Americans have signed up for Medicare Advantage. That’s nearly half the entire Medicare population.

But not just any Medicare Advantage plan will do. And you may here that parts of it are “free” or simpler to sign up for than Original Medicare. It’s important to first read the fine print so that you choose the right plan. Here’s how to avoid trouble when it comes to enrolling in Medicare Advantage. Learn the facts and follow these helpful tips.

Need some help picking a Medicare plan? Call a licensed insurance agent at (800) 827-9990, or compare plans online today.

Medicare Advantage tip #1: If you have a Medicare Advantage plan, you may still have to pay for Medicare Part B.

The facts: When you get a Medicare Advantage plan, you’re purchasing the equivalent of Original Medicare (Medicare Parts A and B), which is normally bundled with Medicare Part D (prescription drug coverage). That means you’ll have to pay a monthly bill for Part B, and you may also have to pay a monthly bill for the plan itself. Depending on your income, some plans may have a $0 premium and may help pay all or part of your Part B premium.

In 2023, your monthly Part B bill can be $164.90 per month. If you don’t pay it, you may be fined or lose coverage altogether.

You may have heard that you can delay payment for Medicare Part B. But that’s only if you have Original Medicare and if you have other creditable coverage, such as coverage through a spouse’s plan. You’ll be able to sign up for Part B later without penalty, but you’d need to do it within 8 months, after your other coverage ends. You’d also need to inform Medicare of your decision before your Part B coverage starts. That’s a long-winded way of saying that you can’t have Medicare Advantage without Medicare Part B.

Remember: You can only have one or the other — Medicare Advantage or Original Medicare. And Part B is a crucial part of both.

Medicare Advantage tip #2: You can’t add Medicare Part D to your existing Medicare Advantage plan with drug coverage.

The facts: Your Medicare Advantage drug plan is the only one you can have. One of the good things about a Medicare Advantage plan is that, usually, all your coverage is bundled together: doctor visits, lab tests and more. Most but not all plans include a Part D prescription drug plan. More than half of all Americans with prescription drug plans get their coverage through Medicare Advantage — stand-alone Part D plans have been declining steadily as more people choose Medicare Advantage.

If you’re on a Medicare Advantage plan that offers drug coverage, but you’re not thrilled with your medication package, you can’t just add on or switch to another one whenever you want to. According to the terms of your Medicare Advantage plan, you can have only one Part D drug plan at a time.

If you do enroll in a Part D stand-alone prescription drug plan while you’re a Medicare Advantage member with prescription drug coverage, you’ll automatically be disenrolled from Medicare Advantage.

The solution: You can file an appeal if the medication you need isn’t on your Medicare Advantage plan’s list of approved medications (aka a formulary). Talk to your doctor about drafting a letter to your insurance company to show that a medication they prescribed you is medically necessary. Or you can find a new plan that better supports your prescription medication needs during Medicare Advantage’s Annual Enrollment Period.

Medicare Advantage tip #3: With a Medicare Advantage plan, you can’t go to any doctor or hospital you choose.

The facts: With Medicare Advantage, you’ll likely need to stick within your provider network, otherwise your health care services will cost a lot more. Your network is your plan’s list of approved doctors, hospitals, and other medical services. For example, your Medicare Advantage plan could be a:

• Preferred Provider Organization (PPO). That means the plan contracts with certain providers, such as doctors and hospitals. So you’ll pay less if you use them and more for out-of-network providers.
• Health Maintenance Organization (HMO). An HMO may limit coverage to specific in-network providers. Generally, HMOs don’t cover out-of-network care, save for emergencies. An HMO may also require you to live or work in a service area.

In other words, you might get a bigger bill than you might expect if you use out-of-network doctors or an out-of-network hospital for surgery and/or complicated treatments.

The solution: Before signing up for a Medicare Advantage plan, check the list of doctors, hospitals, and other providers. Make sure the doctors and facilities that you prefer are in the plan’s network. You can check the plan’s website or review its brochures. Another option? Call a licensed insurance agent at (800) 827-9990 to help you find a plan, or compare plans online today.