Medicare Advantage — pitfalls to avoid

By Kate Ashford
Posted on November 10, 2023

[Ed. Note: We are currently in the thick of Medicare’s annual “open enrollment period,” which runs from October 15 to December 7 every year. That’s the period during which you can a) switch from Original Medicare to a Medicare Advantage plan, or vice versa, b) join, drop or switch to another Medicare Advantage Plan, and c) add, drop or change prescription drug coverage.

It is advisable to review your options every year, as various aspects of health and drug plans may change. This article is focused on those currently in or considering a Medicare Advantage plan.]

Only 3 in 10 Medicare beneficiaries who have a Medicare Advantage plan shop around during open enrollment, according to a 2022 analysis from KFF, a health policy nonprofit. And only 1 in 10 Medicare Advantage enrollees voluntarily switch plans.

A 2020 analysis of Medicare Advantage plan choices by the National Bureau of Economic Research found that more than half of beneficiaries overspent by more than $1,000 due to the plan they selected.

Here are some practices to avoid as you shop for Medicare Advantage this fall:

1. Thinking Medicare Advantage is Medicare

If you’re considering Medicare Advantage, understand that it’s not the same thing as government-provided Medicare. It offers the same benefits, but Medicare Advantage is run by private health insurance companies, and it operates differently.

“You are essentially taking the Medicare coverage that you’ve been provided by the government and turning that in,” said Melinda Caughill, co-founder and CEO of 65 Incorporated, which offers Medicare guidance.

You can switch back to Original Medicare during each year’s open enrollment period, but you may not be able to qualify for an affordable Medicare Supplement Insurance plan, or Medigap, once you’re past the one-time Medigap open enrollment period. (Medigap helps with certain out-of-pocket costs not covered by Original Medicare.)

2. Assuming your doctors are in network

Medicare Advantage plans operate within networks of medical providers, and you usually must see in-network doctors for covered care.

“A lot of people don’t realize that — especially those $0-premium plans — they tend to have fairly confined networks,” said Emily Gang, CEO of the Medicare Coach, a site that provides Medicare guidance. “You want to double-check that your doctor is actually an approved provider in that network.”

Ask your providers what insurance they’ll be accepting in 2024, suggests Sarah Murdoch, director of client services for the Medicare Rights Center, a nonprofit consumer advocacy organization. It’s easier than trying to check each plan’s network individually.

3. Not checking your drug coverage

Like network providers, drug coverage can also change each year. Your drug plan might cover one of your medications differently in 2024, leaving you with more out-of-pocket costs than you expected.

“If you take even one brand name medication, your need to compare plans is incredibly high,” Caughill said. No brand names on your list? Shop around if you take five or more medications in general.

4. Buying for the dental benefits

Medicare Advantage plans usually include benefits that aren’t part of Original Medicare, such as dental, vision or hearing coverage. These extras may be appealing, but don’t let them steer your plan choice.

“First of all, it’s health insurance — so how is it going to cover your healthcare providers and your medications?” said Katy Votava, who holds a doctorate in health economics and nursing and is president and founder of Goodcare, a consulting firm focused on the economics of Medicare.

“If you pick (your plan) for a benefit that isn’t health insurance, you’re often picking wrong. And the dental benefit is pretty limited in all these plans — it’s a couple of cleanings and some bite wings.”

5. Looking at the premium only

The majority of Medicare Advantage enrollees are in plans with no premium, meaning you pay nothing each month for the plan. “People see that $0 premium and they’re like, ‘Oh, it’s free,’” Gang said. “And it’s not.”

Research the rest of the plan’s costs before you sign up, including deductibles, copays, coinsurance and the out-of-pocket maximum, which is the most you might have to spend on covered care in a year. In 2023, the out-of-pocket max can be as high as $8,300 for in-network care.

6. Buying because your friend has it

People eligible for Medicare are bombarded by information during open enrollment, and it can be overwhelming. “They don’t shop,” Votava said. “They go with name recognition or what their friend has.”

The better choice: Focus on your own situation and find the plan that meets your needs.

If you need help, contact your State Health Insurance Assistance Program, or SHIP, for free Medicare guidance. Just don’t wait until the last minute, because appointments fill up, Votava said. “If you need individual help, you’d better get on the list.”