Medicare Questions & Answers: Medicare Advantage
Medicare Advantage Q&A
Showing 40 questions
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans do have some great benefits, but some things to keep in mind are:Medicare Advantage plans has specific doctors and hospitals in their network, so these plans are network based.
Prior Authorizations are needed for some services, which can cause some delay in necessary care.
It's important to check each year to make sure your doctor is still in the network, as this can change from year to year.
Is Original Medicare or Medicare Advantage better? Why do you recommend one over the other?
It will be different for everyone.Original Medicare lets you see any doctor that accepts Medicare and pairs well with a Medigap plan to lower out-of-pocket costs, but it doesn’t cover dental, vision, or prescriptions.
Medicare Advantage bundles everything, often with extra benefits like dental and vision, but you have to stick to a network of doctors.
If you want flexibility, Original Medicare with Medigap is usually better. If you prefer an all-in-one plan with lower upfront costs, Medicare Advantage might be the way to go.
Are Medicare Advantage plans really “free,” or is that just clever marketing?
several carriers offer zero premium plans for medicare advantage plans. they can do this because they get paid by medicare to coordinate your medical care
Do Medicare Advantage plans really save seniors money in the long run? Why or why not?
They can. Medicare Advantage typically offers additional benefits such as Dental, Vision and Hearing- the emphasis on these plans is Preventative Care. The better you take care of your health, the less costly it tends to be.If you break it down, usually a Medicare Advantage plan is about $0 monthly premium, and includes your prescription drug coverage. You will still have to pay your Part B premium (in 2025 the standard premium is $185) and any copayments associated with your plan for doctors visit, procedures, medications. This is why Medicare is considered the Pay as You Go Plan. And that suits some people just fine.
With a Medicare supplement, you are responsible for your Part B premium, your Medicare supplement premium, your prescription drug plan premium and any additional policies you may require such as a Stand-alone Dental, or bundled Dental, Vision and Hearing policy (because Medicare Supplement plans do not include coverage for these). This is why a Medicare Supplement/Medigap plan is known as a Prepaid Plan.
What’s the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
I usually recommend a PPO as you can go to an out of net work provider, sometimes at a higher costs depending on the plan, more providers take PPO. PPO is Preferred Provider. HMO requires referrals, and usually have very narrow networks that you MUST stay in, if you go out of network, YOU pay
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
Yes, you can switch from a Medicare Advantage plan to Original Medicare and subsequently enroll in a Supplemental/Medigap plan during the Annual Enrollment Period (AEP) without needing to answer health questions, as long as you disenroll from the Advantage plan and return to Original Medicare within the first 12 months of your Advantage plan enrollment
If I move to a rural area, how might that limit my Medicare Advantage plan options?
Moving to a rural area could mean fewer Medicare Advantage plans to pick from, since these areas often have lower enrollment and less competition among providers. You might also face narrower networks, making it tougher to find in-network doctors or specialists without traveling farther. In my experience, some rural spots even lack plans with the extra bells and whistles—like dental or vision—that you’d see more of in heavier populated counties.
What should I do if I find out that my preferred hospital isn't in-network with my Medicare Advantage plan?
You can go to any doctor or hospital with Medicare Advantage. Although, there have been instances where a hospital drops the Medicare Advantage plan. You can switch plans during Medicare Advantage open enrollment, Jan 1 to March 31. If you can't find another plan to switch to, you could return to Original Medicare and you could also pair Original Medicare with Medigap.
I picked a Medicare Advantage plan last year, and I’m not sure if my hearing aids are covered. How do I figure this out?
You can find out that in the summary of benefits or evidence of coverage for your current insurance carrier.
What shift has been observed in Medicare spending, particularly regarding Medicare Advantage plans?
Some plans which were in place in 2023 and 2024 have had their Maximum Out Of Pocket (MOOP) increase in 2025.
I have Original Medicare, and I’m wondering if I’d save more on my dental cleanings if I switched to a Medicare Advantage plan instead.
I would never change to a Medicare advantage plan for something like dental cleanings. Depending on your situation you could save in one area while adding more expense to another. If, however, you need extensive dental, the right plan could help you save.Why might Original Medicare with a Part D plan be better than a Medicare Advantage plan for frequent travelers?
It really isn't since original Medicare only pays 80%, the member is responsible for 20% of everything which can become costly. and you have to PAY for Part D every month & pay for your medication. A Medicare Advantage Plan includes drug coverage with Tiers 1 & 2 usually $0 costs , depending g on the planWhat’s the key difference in how Medicare Advantage and Medigap handle out-of-network providers?
Medicare Advantage often ties you to a network—go out-of-network, and you’re either paying more or not covered at all, unless it’s an emergency, which I’ve seen trip up clients who didn’t check their plan’s rules. Medigap, paired with Original Medicare, doesn’t care about networks; any provider accepting Medicare works, giving you flexibility I’ve found folks appreciate when they travel or need specialists. It’s a clear-cut distinction that hits home when you’re picking between the two.
What’s the most misleading Medicare Advantage ad you’ve seen, and how do you explain the reality to clients?
The ones that advertise free dental, OTC cards, and tons of extra benefits — but don’t mention those are usually for people on Medicaid. Most folks don’t qualify for those extras, so it’s very misleading. I always explain what you actually qualify for, not what’s in the fine print.
How is Medicare Advantage expected to evolve in the future?
The future of Medicare will likely see further expansion of MA, driven by consumer demand for more comprehensive coverage and the potential for cost savings through managed care. However, this growth also raises concerns about: Equity: Ensuring that MA plans provide equitable access to care for all beneficiaries, including those in rural or underserved areas. Oversight: Strengthening oversight to prevent fraudulent practices and ensure plans deliver on their promises.
Why are people unhappy with Medicare Advantage plans?
I don’t think they are. My wife and I are on one and we’re very satisfied with it, not to mention the well over a thousand people I’ve written plans for. I think people have preconceived notions and for them that’s reality. Typically you have no premiums for them. Some plans pay down the part B premium Medicare charges, and you have co-pays when you use the plan. Contact me if you’d like to discuss.
Do Medicare Advantage plans save money?
If you have a Medicare Advantage plan and never use it too much it could save you a lot of money. Most Advantage plans I sell are $0 premium a month. However, if you have a lot of chronic conditions and see medical providers often it could cost you a lot of out of pocket expenses. The good thing though there are out-of-pocket maximums on Advantage plans
Why is regular Medicare better than an advantage plan?
There's a lot of confusion with Medicare-Medicare Supplement/Medigap/-Medicare Advantage "alphabet soup"! Do your homework and learn the Pros and Cons of each Option! Work with someone who can offer both: Medicare Supplement/Medigap and Medicare Advantage plans! This was you get the FACTS not the HYPE and then make the best decision for YOU! :)
How can I verify if a Medicare Advantage plan’s advertised benefits are legit?
CMS, Centers for Medicare Services, overseas the Medicare Part C Advantage program. By law, Medicare Advantage plans must be at least as good as Medicare, which is to say that all plans are better than original Medicare. CMS will shut down any plan advertising benefits that are not real. "They've got your back!"
I signed up for a Medicare Advantage HMO, and I’m wondering if I can see a cardiologist out of network without paying everything myself.
This on can be tricky.Using an HMO plan typically means you would want to stay within the network in order to keep your costs as low as possible. If you see a doctor outside of the network, you could end up paying the full cost for that care. There could be some exceptions if this was an emergent care issue while out of network. Be careful seeing an out of network doctor on an elective basis.
Some HMO plans are Point of Service (POS). A POS plan may allow you go out of network for some things. If it is a POS plan, you can probably count on paying a higher price if you choose an out of network provider, however.
Call your plan provider and double check before having the services provided. It's really the only way to know for certain what you're facing. Wish you best!
Does Medicare Advantage cover home health care?
Yes, if your doctor orders it. However, Medicare does not cover 24-hour-a-day care at your home, home meal delivery, homemaker services (like shopping and cleaning) unrelated to your care plan, or custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need. Some Medicare Advantage plans include some homemaker services when returning home from the hospital, so ask your broker.
My diabetes medication is super expensive, and I've heard horror stories about Part D not covering what people need. Should I go standalone Part D or get it through a Medicare Advantage plan?
I cannot say it is covered, and how much depends on what kind of medication you take and the Part D plan provided by the health insurance company. You should contact Medicare agents and make an appointment.
My mom is considering switching to a Medicare Advantage plan because her friends say it's better. She's scared of losing her current doctors. How can we check?
Her friends may endanger your mother. Medicare Advantage may have authorizations, Dr networks, service areas, referrals, Etc. It's easy for any Medicare broker to check her current doctors and see if they are in network for various Medicare Advantage plans.
I picked a PPO for the flexibility, but now every time I go out of network the bills are outrageous. What’s the point of even having a PPO?
Preferred Provider Organization, each Health Insurance company has a PPO Network and it is prudent to work within that Network if you can. PPO's are more costly for insurance companies because of the Out of Network usage. Try to work within your PPO Network to keep your costs down. Your Local Broker should be able to direct you to a copy of your Local Network of Providers. Your Insurance provider also has ways to search for In Network Physicians.Why would you not choose a medicare Advantage plan?
There are both Pros and Cons with Medicare Advantage! There are usually OOP (out of pocket maximums from $4500-$10,000 per year) and with Med Advantage the Insurance company makes the decisions on what surgeries are "necessary". We give client options between both Medicare Advantage and Medicare Supplement! We provide the Pros and Cons of both and let the client make the decision that's best for them!
Does Medicare Advantage cover acupuncture or alternative therapies in some plans?
Yes Some Medicare Advantage plans may cover Acupuncture. Always check your Summary of Benefits. The Acupuncture benefit could be covered for chronic low back pain only. Not all providers could be included.also See page 30 in your Medicare and You Handbook 2025
How do Medicare Advantage star ratings affect the quality of care I can expect?
Medicare advantage ratings are a great way to rate the effectiveness of a plan. If you just go off of a plans benefit amounts, you may be turning a blind eye to poor service or low network quality. The star ratings really do give an accurate description of how well or poor a plan performs..Will Medicare Advantage plans start offering more digital health tools like apps by 2030?
Many Healthcare companies are offering wellness apps, mental health apps, fitness and exercise. I can only see those opportunities increasing as the desire to keep our Seniors healthy and fit is so important.I’ve got a Medicare Advantage plan, and I’m curious if my upcoming eye surgery is fully covered or if I’ll owe extra out of pocket.
That would be a great question to ask the provider prior to the surgery. A good ophthalmologist office Is usually very aware of the codes that they will bill to Your Medicare advantage plan And they may Tell you your cost. You should also be able to contact your Medicare advantage plans member services number and they can answer that question for you. If it is a cataract surgery, that’s a little different. Medicare fully covers cataract surgery with a standard lens. If you are using any type of upgraded lens, then Medicare will not pay for the upgraded lens And you will be financially responsible for that cost.I have Medicare Advantage with a PPO, and I’m curious if my annual wellness visit is free or if I’ll owe something for it.
Your plan more than likely will have a zero dollar co-pay for your annual wellness visit however, it’s always a good idea to double check your summary of benefits to make sure.Can I keep seeing my current doctors if I switch to a Medicare Advantage plan, or do I have to find new ones?
You may or may not keep your current doctor's when switching to a Medicare advantage plan. Some HMO's and PPO's have extensive networks and your doctors may all participate. If you decide on an HMO you just stay in network. PPO's allow you to go out of network though your cost may be higher.
How do you explain to clients that “zero-premium” doesn’t mean “zero-cost” with Medicare Advantage?
My Daddy use to say, "Son, there ain't no such thing as a free lunch." This is the case with the zero dollar premium Medicare Advantage(MAPD.) In order to enroll in a MAPD, you have to be enrolled in Medicare A AND B, so you still have to pay your Part B premium.The Zero Premium does not mean "zero cost." MAPD plans are a "Pay as you go" plan. Depending on what plan you enroll in you may have co pays for Doctor visits, Specialist, and Hospital stays.
What’s your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
I have a seven question algorythm that is 99% accurate. Seven questions and the appropriate strategy is evident.
What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?
Benefits that are advertised nationally that only a super small percentage of the population (usually poverty level) qualify for. It's misleading for our senior population and creates confusion when there doesn't need to be any.
What's the best way to compare my current Medicare supplement plan to a Medicare advantage plan?
I always tell my clients to count up the cost. Write down all the out-of-pocket cost to have a Medicare Supplement plan and what your cost will be if you sign up for a Medicare Advantage plan. If you would like to discuss and compare plans, you may give Melissa Barton a call at 473-242-8437.
I picked a Medicare Advantage plan because of the dental and now I found out it only covers cleanings. Why didn’t anyone tell me this upfront?
I’m sorry to hear you’re feeling frustrated about your Medicare Advantage plan’s dental coverage—it’s totally understandable to expect more clarity upfront. As a Medicare agent, I didn’t help you pick this plan, but I’m happy to shed some light on what might’ve happened. Dental benefits in Medicare Advantage plans can vary a ton, and sometimes the details get buried in the fine print. A lot of plans advertise “dental coverage” to draw folks in, but they might only cover basics like cleanings and exams, not bigger stuff like fillings or crowns. It’s possible the plan’s summary highlighted the dental perk without spelling out the limits, and unless someone walked you through the Evidence of Coverage document, those specifics can slip by. I’d love to help you review your plan now—maybe we can find a better fit for next enrollment if you need more than cleanings.
Is it better to get Medicare Part D or Medicare Advantage?
There really isn't a perfect answer to this question. It is based on what each person's needs and the how they want to be covered. The best choice really is an individual choice and how they look at their insurance needs and money they want to have to spend monthly on their insurance.More often Part D plans will have a higher Deductible and copay costs over a Medicare Advantage, so looking at each person's medications is a must when deciding on these plans.
Why do some agents push Medicare Advantage plans over Medigap—should I be skeptical?
If you have an agent who pushes any certain plan you should be skeptical, and the said agent is probably not looking out for your best interest. No one plan is perfect for everyone. You need to know the differences between Original Medicare and Medicare Advantage plans and how they could affect your healthcare.
As a senior, what should I know about the differences between Original Medicare and Medicare Advantage before I choose?
Basic Original Medicare by itself covers Part A (hospital stays) and Part B( doctor visits). You usually pay a monthly Part B premium, which is paid by Social Security Administration from your benefits, and you must meet yearly deductibles. Original Medicare will then cover 80% of the approved amount, and you're responsible for the remaining 20% of the cost of care. There is no limit to your out-of-pocket cost each year. You may need a supplemental insurance plan to cover 20% of the cost of care and prescription drug coverage.
Medicare Advantage plans are more comprehensive plans that support your entire well-being, so you can live a better, healthier life. You usually pay a monthly Part B premium, which is paid by Social Security from your benefits.
In one package, it gives you Part A and Part B coverage, plus Part C coverage.
Many plans also include Part D prescription drug coverage. It has limited out-of-pocket cost, It has more predictable co-pays, and a cap to your yearly out-of-pocket expenses.
Should there be stricter regulations on Medicare Advantage marketing and sales practices?
No. The regulations make is harder for honest people and the seniors. The issues is that the dishonest people are NOT following the rules. Calling Seniors with permission to contact forms. They are signing them up without Scope of Appointments.The high pressured scammers are the problem and not following any rules. I get calls every 10 minutes from people trying to pressure me and make false claims about insurance and I am a broker!!