5 Myths About Medicare Advantage Plans—Busted!

By Kelly Spors |

Don’t fall for these common misconceptions. Here’s what to know during Medicare Open Enrollment.

medicare advantage myths

Count Medicare as one of those parts of life that everyone has thoughts on.

Chances are you’ve been collecting Medicare tips from every possible source: relatives, neighbors, even strangers in the waiting room at the doctor’s office. One friend claims he has the best, most comprehensive coverage. Another insists her plan is the most affordable one out there.

No doubt all of this advice is well-intentioned. But here’s the thing: You’re the one who knows your health needs and budget.

That’s why Medicare Open Enrollment—which runs from October 15 to December 7—is so important. If you have a Medicare Advantage Plan (Part C) or are considering switching from Original Medicare (Parts A and B) to a Medicare Advantage Plan, now’s your chance to make sure you’re happy with your coverage for the coming year.

To help you do that, we’ve debunked some common Medicare myths you might have seen floating around.

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Myth #1: All Medicare Advantage Plans Are Essentially the Same

Actually, Medicare Advantage Plans often have significant differences. Among them: provider networks, prescription drug coverage, and premiums.

Many Medicare Advantage Plans also bundle in extra benefits that Original Medicare doesn’t cover. This can include vision, hearing, and dental coverage. It can also include fitness programs like SilverSneakers. And thanks to new Medicare rules, you may see even more extras than in the past, such as transportation to doctor appointments or benefits for people with certain chronic conditions.

Not all Medicare Advantage Plans will offer these extras, so if they’re important to you, you’ll want to keep those in mind as you review your coverage.

Myth #2: My Medicare Advantage Plan Will Stay the Same

It might, but it might not. Medicare Advantage Plans can change their provider network, prescription drug coverage, and costs—including premiums, deductibles, coinsurance, and copayments—each year.

If your Medicare Advantage Plan is changing, you’ll receive an Annual Notice of Change (ANOC) document in September. It’s important to review this document to understand any changes in the coming year, especially if you need a specific service or drug.

Didn’t get an Annual Notice of Change document or need more information about any changes? Contact your plan.

Myth #3: If My Medicare Advantage Plan Stays the Same, My Costs Will Stay the Same

They may, but they may not. Even if your premiums, deductibles, coinsurance, and copayments don’t change, there’s another important factor to consider: your health. Now’s a good time to review your current health needs—and anticipate potential costs.

To start, you may want to check your recent claims and any notes from your doctors. Did you have any major changes in your health or unexpected health care costs in the past year? Do you need ongoing treatment, or are you at higher risk for any conditions?

Then think about any costs you might encounter, even if you haven’t previously needed a service before. If you have or are considering a Medicare Advantage Plan, do you know the coinsurance or copayments for:

  • Primary doctor visits
  • Specialist visits
  • Emergency care
  • Urgent care
  • Ground ambulance

Myth #4: I Have to Stick with My Medicare Advantage Plan

If you like your current coverage and it’s available in the coming year, you can certainly stick with it. You don’t have to do anything during Open Enrollment, and your current Medicare Advantage Plan will automatically renew.

However, if you’d like to join a new Medicare Advantage Plan or switch from Original Medicare to Medicare Advantage for the coming year, you can during Open Enrollment. You can see your options at medicare.gov/plan-compare. You can typically join a Medicare Advantage Plan online or by phone, and you’ll need your Medicare number, which is on your Medicare card.

If you join a new Medicare Advantage Plan, your old coverage will end December 31, and your new coverage will start January 1.

During Open Enrollment, you also have other options, including switching from Medicare Advantage to Original Medicare. Learn more with these answers to common questions about Medicare Open Enrollment.

Myth #5: I Can Change Medicare Advantage Plans Whenever I Want

No, you can only change Medicare Advantage Plans at certain times of the year. The most important dates to remember are:

October 15 to December 7, 2019: You can join, switch, or drop Medicare Advantage Plans for the coming year. This includes switching from Original Medicare to Medicare Advantage, or vice versa.

January 1 to March 31, 2020: If you have a Medicare Advantage Plan, you can switch or drop coverage—but you can only make one change during this period. During this time, you can switch from Medicare Advantage to Original Medicare, but you cannot switch from Original Medicare to Medicare Advantage.

In certain circumstances, such as if you move to a new area or have other life events, you may be eligible for special enrollment periods.

What’s Next?

Don’t let inertia or fear prevent you from making the most of Open Enrollment, which ends December 7. If you currently have a Medicare Advantage Plan, it’s important to check your Annual Notice of Change document for any changes in the coming year. Or if you’ve been considering switching from Original Medicare to Medicare Advantage, now’s your chance to explore your options.

For help, check out these resources:

Ready to Get Started with SilverSneakers?

SilverSneakers is a health and fitness program designed for adults 65+ that’s included with many Medicare Plans. Learn more about SilverSneakers here.

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