How Medicare Advantage works and what to consider when choosing a plan

Core Insights - The article discusses the complexities and changes in Medicare Advantage plans, emphasizing the importance of understanding the benefits and costs associated with different plans offered by private insurers [1][2][3]. Group 1: Medicare Advantage Overview - Medicare Advantage, also known as Part C, is a Medicare-approved plan provided by private insurers that combines hospital insurance (Part A), medical insurance (Part B), and usually prescription drug coverage (Part D) into a single package [2]. - The number of Medicare Advantage plans has decreased, and many plans have weakened in terms of benefits, creating challenges for beneficiaries during the open enrollment period [3]. Group 2: Enrollment and Costs - From October 15 to December 7, beneficiaries can enroll in, switch, or drop Medicare Advantage or drug plans, or revert to Original Medicare [2]. - In 2025, over 76% of enrollees in individual Medicare Advantage plans with drug coverage paid no premium beyond the standard Part B premium [7]. - The annual out-of-pocket maximum for Medicare Advantage plans in 2025 is capped at $9,350 for in-network services and $14,000 for combined in- and out-of-network services, with average out-of-pocket maximums of $5,320 for in-network care and $9,547 for PPO plans [8]. Group 3: Choosing the Right Plan - Beneficiaries should focus on total healthcare costs rather than just premiums, as a $0-premium plan may end up costing more in the long run due to higher out-of-pocket limits [9]. - It is crucial to ensure that all necessary prescriptions are covered in the chosen plan, as this significantly impacts annual out-of-pocket costs [5][9]. - Additional benefits such as vision, dental, and gym memberships can influence the decision, but their importance varies by individual needs [6]. Group 4: Understanding Coverage and Penalties - Beneficiaries without prescription drug coverage face a Part D penalty, which is a permanent surcharge added to monthly premiums if they go without coverage for 63 days or more after their initial enrollment period [4]. - Insurers cannot deny coverage based on health status, ensuring that individuals can enroll in Medicare Advantage plans regardless of their healthcare needs [11]. Group 5: Consumer Protection - Scammers often target older adults during open enrollment with misleading ads and calls, highlighting the need for vigilance and verification of caller credentials [11][12]. - Consumers can verify the legitimacy of callers by asking for their National Producer Number (NPN) and checking it through their state insurance commissioner's office [13].