This article was last updated Aug. 11, 2023.
If you’re approaching the deadline to sign up for Medicare or you're reviewing your options for the upcoming year, you may have questions about your coverage. You know you need to sign up for Original Medicare within the seven months surrounding your 65th birthday, but also know that Original Medicare may not cover everything you need.
There are two common paths for ensuring additional coverage once you’re signed up for Medicare: Medicare Advantage and Medicare Supplement (also known as Medigap). In this article, we’re answering your top questions about Medicare Advantage so you can decide if it’s right for you.
Medicare Advantage basics
No matter the kind of extra coverage you choose, you need to first enroll in Original Medicare (Parts A and B), which is managed by the federal government. When you sign up for Medicare Advantage (also known as Part C), a private health insurance company manages your Part A and B benefits, and often prescription drug benefits (Part D), all together in one plan.
Coverage provided by a Medicare Advantage plan is required to be as good as or better than benefits under Original Medicare. Medicare Advantage benefits may include:
- Low or no monthly premiums
- Premiums that remain the same regardless of age or health status
- Lower copays or deductibles compared to Original Medicare
- An out-of-pocket maximum for more predictable spending
- Additional benefits like routine vision, hearing, dental and healthy living benefits — at no additional cost
What does Medicare Advantage cover? Medicare Advantage plans provide hospital coverage, medical coverage, prescription drug coverage, dental care, vision care, hearing care, and gym memberships. Some plans may not cover all the items listed, and some plans may provide even more coverage. You'll need to look at the specific plan you're interested in for more details.
Answering your top Medicare Advantage questions
Now that you know the basics, let’s get into the most common questions about Medicare Advantage plans.
Can I keep seeing my doctor with Medicare Advantage?
Medicare Advantage plans use a network of doctors and hospitals. The federal government ensures everyone with Medicare Advantage has access to quality in-network providers, and requires plans to help members find a provider or cover services at the in-network rate if there isn’t an in-network specialist available. When choosing your plan, review the plan's provider directory to make sure your current doctor(s) is in-network.
Turning 65? Request the Medicare Advantage guide
Learn about the different parts of Medicare when you download the educational Medicare guide. Also your coverage options and when you're eligible to enroll.
Am I covered by my Medicare Advantage plan when I travel?
Some Medicare Advantage plans include a travel benefit. Whether you’re traveling for a few weeks or several months, your Medicare coverage travels with you wherever you go, and you’re always covered at in-network rates if you have an emergency.
Are there any downsides to Medicare Advantage
Low or no monthly premiums, extra health and fitness benefits, and coverage while you’re traveling make Medicare Advantage a great choice for many. While many Medicare Advantage plans offer a low or no monthly premium, there are out-of-pocket costs you'll need to plan for. Plus, because most plans typically have a network of providers you must see to keep costs as low as possible, you will also need to make sure your doctor is in your plan's network or find a new one. If you need more help deciding on a plan that's best for your lifestyle and budget, you can speak to an authorized Wellmark agent to discuss your options at no cost to you.
Can I expect the same benefits and coverage from all Medicare Advantage plans?
Unlike Medicare Supplement plans, which provide standardized coverage across all health insurance carriers, Medicare Advantage plans differ based on the private health insurance company you choose. Typically, those differences include varied provider networks, premium costs, prescription drug coverage, and extra benefits.
If I pay a premium for Medicare Advantage, do I still have to pay my Part B premium?
To be enrolled in a Medicare Advantage plan, you need to first be enrolled in Original Medicare. This means you will still need to pay the monthly Part B premium in addition to your Medicare Advantage premium. Many Medicare Advantage plans help you pay all or part of your Part B premium with low or $0 premiums.
Aren't Medicare Advantage and Medicare Supplement the same thing?
Medicare Supplement, sometimes known as Medigap, fills in coverage gaps in Original Medicare and does not provide all-in-one coverage like some Medicare Advantage plans. Medicare Advantage plans usually includes drug coverage and extras like dental, vision, hearing and fitness benefits, while you must purchase these coverage options separately with Medicare Supplement. You can’t have both Medicare Advantage and Medicare Supplement, so you’ll need to choose the option that’s right for you.
How much does Medicare Advantage cost?
While the cost of Medicare Advantage plans differs among insurance providers, Medicare Advantage premiums start as low as $0. The type of plan you choose will also determine how much you will pay. Some plans have a higher premium but more widespread coverage, while others may have a lower premium and a more limited network of providers. You’ll need to consider your healthcare needs when deciding which Medicare Advantage plan is right for you.
Other Medicare Advantage considerations
Depending on your healthcare needs, a Medicare Advantage plan may not be the right fit for you. Consider these points of Medicare Advantage.
| Consider this: | What to know: |
|---|---|
| Some Medicare Advantage plans may have lower premiums, but higher out-of-pocket costs compared to Medicare Supplement. |
Consider your needs and ability to pay for medical services or prescription drug costs. If you’re in good health, your out-of-pocket costs may be lower. |
| Medicare Advantage plans have limited provider and hospital networks. |
If you travel frequently or split your time between states, be sure to check the network of doctors and hospitals in the Medicare Advantage plan you are considering. Many Medicare Advantage plans have coverage out of state. |
| There are specific times during the year you can switch from a Medicare Advantage plan to another plan. |
Make sure you feel confident in your choice when selecting a plan during your Initial Enrollment Period. If you decide to switch from a Medicare Advantage plan, you can do so during the Annual Enrollment Period or Open Enrollment Period. |
| Medicare Advantage considerations | |
|---|---|
| Some Medicare Advantage plans may have lower premiums, but higher out-of-pocket costs compared to Medicare Supplement. | What to know: Consider your needs and ability to pay for medical services or prescription drug costs. If you’re in good health, your out-of-pocket costs may be lower. |
| Medicare Advantage plans have limited provider and hospital networks. |
What to know: If you travel frequently or split your time between states, be sure to check the network of doctors and hospitals in the Medicare Advantage plan you are considering. Many Medicare Advantage plans have coverage out of state. |
| There are specific times during the year you can switch from a Medicare Advantage plan to another plan. |
What to know: Make sure you feel confident in your choice when selecting a plan during your Initial Enrollment Period. If you decide to switch from a Medicare Advantage plan, you can do so during the Annual Enrollment Period or Open Enrollment Period. |
Have more questions about Medicare Advantage?
We're here to help. If you live in Iowa or South Dakota, call us directly at . If you live outside Iowa or South Dakota, visit the Blue Cross Blue Shield Association website External Site.
Wellmark Advantage Health Plan is a PPO and an HMO plan with a Medicare contract. Enrollment in Wellmark Advantage Health Plan depends on contract renewal.
Y0156_MedAnsrWb_M CMS Accepted 10032023
