Personal Finance

The Top 4 Questions to Ask Before Choosing a Medicare Advantage Plan

Maurie Backman

Published: February 4, 2025 9:44 am

Once you turn 65, you’re generally entitled to Medicare coverage. But you don’t have to stick with original Medicare (Parts A and B plus a Part D drug plan). Instead, you could sign up for a Medicare Advantage plan.

Medicare Advantage is an alternative to original Medicare. These plans provided by private insurers can offer certain benefits beyond original Medicare, so they’ve become an increasingly popular choice among seniors.

But if you’re going to choose a Medicare Advantage plan, it’s important to find the right one. Here are some questions you’ll need to ask before committing.

1. What network-related restrictions will I have?

Enrollees in original Medicare can pretty much see any provider in the country that accepts Medicare. With Medicare Advantage, you may be limited to a more narrow network of providers. So it’s important to know what restrictions you’ll face.

If your plan is an HMO, you’ll generally be limited to care within your plan’s network. You’ll usually have to pick a primary care physician, and you should expect to need a referral to see a specialist.

If your plan is a PPO, you may be able to use providers that are out of network (albeit at a higher cost than in-network providers). But you generally don’t have to designate a primary care physician or obtain a referral every time you need to see a specialist.

2. What costs will I incur?

Generally speaking, HMO plans have lower out-of-pocket costs than PPO plans. But even within each category, there are costs you’ll need to review. These include:

• What your plan’s premiums look like (though it’s worth noting that a good number of Medicare Advantage plans have $0 premiums)
• What your plan’s out-of-pocket maximum is
• What deductibles you’re subject to

3. What does my prescription drug coverage look like?

One benefit of signing up for Medicare Advantage is that it typically gives you all-in-one coverage — meaning, you don’t need a separate drug plan. But it’s important to make sure the medications that you specifically take are covered by your plan.

Keep in mind that even if the drugs you take are covered, your costs may be high, depending on your plan. Medication coverage should be a big factor in your decision since this is likely to be a recurring cost for you.

4. What supplemental benefits does my plan offer?

One big perk of choosing Medicare Advantage over original Medicare is that these plans commonly offer supplemental benefits. It’s common for Medicare Advantage plans to pay for dental care, eye exams and glasses, and hearing aids, all of which are services original Medical doesn’t cover.

But some Medicare Advantage plans go way beyond these basics, offering benefits that range from fitness center access to meal delivery. It’s important to compare benefits so you know what you’re paying for and what you’re getting.

It’s also important to find a Medicare Advantage plan with benefits that you can personally use. You may find a plan that offers meal delivery, for example. But if you don’t have a medical condition that can be managed by dietary changes, then you may be not qualify for that benefit.

Make your decision carefully

All told, there are lots of good reasons to look at a Medicare Advantage plan for your healthcare needs. But it’s important to choose your coverage carefully, and to review all of the pros and cons.

One general problem with Medicare Advantage plans is that many services and treatments require prior authorization, which could not only be a hassle, but potentially delay your care. So take the time to read up on Medicare Advantage plans in general before diving in.