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What are the advantages and disadvantages of Medicare Advantage plans?

Advantages of Medicare Advantage Plans

Medicare Advantage (Part C) plans can offer you more than you would have with Original Medicare. Explore plan options and take time to consider your budget and your coverage needs to see what works best for you.

The advantages of a Medicare Advantage plan

Most Medicare Advantage plans include benefits you may need that are not covered by Original Medicare, including:

  • Routine dental care, including X-rays, exams, and dentures.
  • Vision care, including glasses and contacts.
  • Hearing care, including testing and hearing aids.
  • Prescription drug coverage.
  • Wellness programs and fitness center membership, including SilverSneakers®.

Many Medicare Advantage plans feature low premiums (sometimes $0). Medicare Advantage plans also cap your maximum out-of-pocket expenses for Part C covered services. Once you reach the cap, you pay nothing for the rest of the year. Be sure to compare the Medicare Advantage plans’ costs along with coverage.

How does Medicare Advantage compare to Original Medicare?

Original Medicare includes Part A and Part B. Part A covers hospitalization, home care, and other inpatient medical needs. Part B covers outpatient care, such as doctor visits, medical tests, screenings, and preventive care. If you need more coverage, Medicare Advantage plans include Medicare Part A and Part B coverage, plus additional benefits.

More to know about a Medicare Advantage plan

You still have to pay your Medicare Part B premium along with your Medicare Advantage plan premium.

Some Medicare Advantage plans may offer fewer options when it comes to doctors and hospitals, as they may have smaller plan networks than Original Medicare. And if you sign up for a Medicare Advantage plan with an HMO network, you may need a referral from your primary care doctor to see a specialist. If you’re still working, you may not be able to use your Medicare Advantage benefits with an employer health plan.

Questions to ask while comparing Medicare Advantage plans

Finding the best Medicare Advantage plan may be worth it for the extra coverage. Be sure to ask the right questions to get the most out of the plan you pick.

  • Are your preferred hospitals or preferred doctors included in the Medicare Advantage plan? 

Doctors and hospitals in a plan’s network can change yearly, so it’s best to make sure your family doctor is still in the plan after your initial enrollment. Just ask when you go for a doctor visit.

  • Which prescription drugs are covered?

You can use our find a drug tool to see what drugs are available in the plan. If you need medications, are they available and affordable under a selected plan?

  • What is the maximum out-of-pocket amount?

A lower out-of-pocket maximum may be preferable, so you have coverage for unexpected injuries or illnesses.

Medicare Advantage and the CARES Act

The Coronavirus Aid, Relief, and Economic Security (CARES) Act has some benefits for Medicare Advantage plans. Federally Qualified Health Centers and Rural Health Clinics must provide telehealth services to people with Medicare. The CARES Act also requires all Medicare Advantage prescription drug plans to allow members to obtain a 90-day supply of covered drugs without restrictions.

How do you sign up for a Medicare Advantage plan?

You can use the Annual Enrollment Period (October 15 – December 7) to sign up for a Medicare Advantage plan for the first time if you currently have Original Medicare.

How do you change your Medicare Advantage plan?

If you chose a Medicare Advantage plan that doesn't provide the coverage you need or if the cost becomes too expensive, you have the option to change to other plans once a year during the Medicare Advantage Open Enrollment Period. During this time, you can change or drop an existing Medicare Advantage plan.

Find a Medicare Advantage plan that fits your needs and budget.

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Y0114_21_3000532_U_M CMS Accepted (07/17/2021)

Benefits, premiums, copays and plan may vary by county. Medicare Advantage plans may not be available in all counties.

The Medicare Advantage and Medicare Part D plans are health plans with a Medicare contract or a standalone prescription drug plan with a Medicare contract. The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.  In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.

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For Dual-Eligible Special Needs Plans: This plan is available to anyone who has both Medical Assistance from the State and Medicare.

This information is not a complete description of benefits. Call Customer Service, (TTY: 711) for more information.

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