Main points
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Because Medicare Advantage plans are different, it’s important to understand your plan’s rules.
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Understand your costs and benefits.
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Understand which providers are available to you, and recognize that you can withdraw if you’re not satisfied with your coverage.
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Once you reach age 65, you are eligible for health insurance through Medicare. But you don’t have to stick with Original Medicare.
Many seniors choose to enroll in a Medicare Advantage plan instead of original Medicare. Doing so may have different benefits.
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For one thing, Medicare Advantage plans often offer benefits beyond what original Medicare pays. Medicare Advantage plans also have caps on annual out-of-pocket expenses. That’s huge when you’re on a tight budget for Social Security benefits and have modest retirement plan withdrawals.
But while Medicare tends to have the same rules for all enrollees, Medicare Advantage varies by plan. So whether you’re in a new plan or the same plan in 2025, it’s important to understand your coverage this year and what rules you must follow. Here are four things to keep in mind.
1. What does your fee include?
Medicare Advantage plans change every year, which means your costs may go down or up. It’s important to understand the costs like premiums, deductibles, and copays that you’re concerned about so you can budget accordingly.
Keep in mind that even if you have Medicare Advantage, you still need to pay Medicare Part B every month. However, some Medicare Advantage plans cover enrollees’ Part B premiums.
2. What does your provider network look like?
One disadvantage of Medicare Advantage plans is that they limit enrollees to a specific provider network. With Original Medicare, you can see almost any doctor in a country that accepts Medicare.
Be sure to familiarize yourself with your plan’s provider network, as going off-network can be very expensive for you. And don’t assume that if your provider was in network last year, it will be the same this year. The Medicare Advantage plan network changes every year.
3. What supplemental benefits are you eligible for?
Another benefit of enrolling in Medicare Advantage is that these plans often offer supplemental benefits beyond what original Medicare pays. You’ll often find that Medicare Advantage plans pay for things like dental care, eye exams, and hearing aids, but Original Medicare doesn’t cover these services.
Some Medicare Advantage plans offer additional benefits, such as home cleaning services and meal delivery services. It’s worth it to see what additional benefits your plan may bring. But before you get excited about these benefits, you need to check the eligibility rules.
Your Medicare Advantage plan may offer meal delivery, but only if your health condition can be controlled by changing your diet. Your plan may offer home cleaning services, but only if you have asthma or a similar condition, and depending on the diagnosis you receive, cleaning the air can improve lung health.
4. What are your options for switching coverage?
At this point, it may be too early to get tired of your Medicare Advantage plan. But if you realize in the next few weeks that you chose the wrong plan or that you should have made a change during open enrollment last fall, that’s not so bad.
Medicare Advantage has its own special open enrollment period each year, which runs from January 1 to March 31. During this window, you can switch to a different Medicare Advantage plan if your current plan doesn’t seem to be working well. You can also drop Medicare Advantage and switch to Original Medicare.
Get to know your Medicare coverage early
As a retiree, health care can be one of your largest expenses. Your specific Medicare Advantage plan may affect how much you spend.
Be sure to familiarize yourself with your plan’s rules, fees, and benefits at the beginning of the year so you can get the most out of your coverage and avoid unnecessary surprises. Remember, you won’t necessarily stick to your plan during 2026, so don’t hesitate to make changes if there are obvious aspects of your plan that you’re not happy with.
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4 Things You Need to Know About Medicare Advantage Plans in 2026 Originally published by The Motley Fool
