13 things to know about Medicare Advantage Plans

  1. You're still in the Medicare Program.
  2. You still have Medicare rights and protections.  
  3. You still get complete Part A and Part B coverage through the plan.
  4. You can only join a plan at certain times during the year. In most cases, you're enrolled in a plan for a year.
  5. You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).
  6. You can check with the plan before you get a service to find out if it's covered and what your costs may be.
  7. You must follow plan rules, like getting a referral to see a specialist to avoid higher costs if your plan requires it. The specialist you're referred to must also be in the plan's network . Check with the plan.
  8. If you go to a doctor, other health care provider, facility, or supplier that doesn't belong to the plan's network, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.
  9. Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.
  10. If you join a clinical research study, some costs may be covered by your plan. Call your plan for more information.
  11. Medicare Advantage Plans can't charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
  12. Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for all medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan.
  13. If the plan decides to stop participating in Medicare, you'll have to join another Medicare health plan or return to Original Medicare.