Common Misconceptions about Medicare Advantage

Medicare Advantage plans, also known as Part C, are an increasingly popular choice for many older adults. These plans offer an alternative to Original Medicare by providing all-in-one coverage that often includes additional benefits like dental, vision, and hearing. However, despite their growing popularity, there are still many misconceptions about how these plans work. Clearing up these misunderstandings is important, especially as Medicare enrollment periods approach, and many people are weighing their coverage options.

7 Common Misconceptions about Medicare Advantage

Misconception 1: Medicare Advantage Replaces Medicare

One of the most widespread misconceptions is that enrolling in a Medicare Advantage plan means you are no longer part of Medicare. This is not true. When you choose a Medicare Advantage plan, you remain enrolled in Medicare. The key difference is that your coverage is provided by a private insurance company instead of the federal government. Your plan must follow Medicare’s rules, but it may offer additional benefits that Original Medicare does not.

Misconception 2: Medicare Advantage Plans Are More Expensive

Another common belief is that Medicare Advantage plans are always more expensive than Original Medicare. In reality, the costs vary depending on your healthcare needs and the specific plan you choose. Some Medicare Advantage plans have low or even zero monthly premiums, though they may include other costs like copayments or out-of-pocket limits. For some, especially those who frequently need medical services, Medicare Advantage plans could save money due to the cap on out-of-pocket expenses.

Learn more about the cost of Medicare Advantage plans here.

Misconception 3: You Can Only Use Certain Doctors

It’s true that Medicare Advantage plans often have a network of preferred doctors, but this doesn’t necessarily mean you are restricted to seeing only those providers. Some plans, such as Preferred Provider Organization (PPO) plans, allow you to see doctors outside the network, albeit at a higher cost. If you want to keep your current doctor, it’s essential to check whether they are in the plan’s network before enrolling. On the other hand, Health Maintenance Organization (HMO) plans typically require you to stay within the network, but they often offer lower premiums and out-of-pocket costs.

Explore your healthcare provider options here.

Misconception 4: Switching Back to Original Medicare Is Impossible

Many people believe that once they’ve joined a Medicare Advantage plan, they’re stuck with it for life. Fortunately, this is not the case. You can switch back to Original Medicare during certain times of the year, such as the annual open enrollment period or the Medicare Advantage open enrollment period (January 1 to March 31). If you’re not happy with your plan or your healthcare needs have changed, these enrollment periods give you the flexibility to make a switch.

Learn about switching back to Original Medicare here.

Misconception 5: Medicare Advantage Plans Don’t Offer Adequate Coverage

Some people worry that Medicare Advantage plans won’t cover the services they need. However, these plans must cover everything that Original Medicare does and often include additional benefits. For example, many Medicare Advantage plans include prescription drug coverage, something that requires a separate Part D plan under Original Medicare. Some plans also offer wellness programs, gym memberships, and preventive care services that aren’t available with Original Medicare.

For more details on Medicare Advantage coverage, visit Medicare.gov.

Misconception 6: Medicare Advantage Is the Same as Medigap

Another misconception is that Medicare Advantage and Medigap (Medicare Supplement Insurance) are the same. They are not. Medigap policies help cover out-of-pocket costs that Medicare doesn’t cover, such as copayments and deductibles. Medicare Advantage plans, on the other hand, are all-in-one plans that bundle hospital, medical, and often prescription drug coverage. You cannot have both Medicare Advantage and a Medigap plan at the same time.

Learn more about the differences between Medicare Advantage and Medigap here.

Misconception 7: All Medicare Advantage Plans Are the Same

Not all Medicare Advantage plans are created equal. Different plans can vary widely in terms of costs, coverage options, and provider networks. Some plans focus more on wellness and preventive care, while others may offer more extensive drug coverage. It’s important to compare plans carefully, considering your health needs and financial situation. Each year during the open enrollment period, you have the chance to review your plan and make changes if needed.

To compare plans, visit Medicare.gov.

Understanding the realities of Medicare Advantage can help you make an informed decision about your healthcare.

Don’t let misconceptions stand in the way of getting the coverage that works best for you. Whether you’re looking for more comprehensive coverage, lower out-of-pocket costs, or additional benefits like dental or vision, a Medicare Advantage plan could be a great option.

If you're unsure which plan is right for you, consider exploring classes on Medicare through GetSetUp, where you can learn more about your healthcare options, connect with others, and ask questions.

Reviewed By: Keith Gilbert