8 Questions to Ask Before Choosing a Medicare Advantage Plan
March 16, 2026
Many people nearing Medicare eligibility are accustomed to employers covering most of their health insurance costs. As age 65 approaches, however, it often comes as a surprise that Medicare still requires meaningful out-of-pocket spending.
“Medicare isn’t free,” notes Steve Feinschreiber, senior vice president on the financial solutions team at Fidelity. “In fact, the program can become fairly expensive and it doesn’t pay for every medical cost you might incur. Many retirees end up needing supplemental coverage to help fill those gaps. Without it, you could be responsible for significant remaining bills.”
Because of this, it’s important to understand your coverage choices before enrolling. In general, Medicare coverage can be obtained in two primary ways:
Original Medicare through the federal government.
With this approach, you enroll in Medicare Part A (hospital coverage) and Part B (medical coverage). You then select a Part D prescription drug plan and, if desired, purchase a separate Medicare Supplement (Medigap) policy to help cover deductibles and coinsurance.
Medicare Advantage plans offered by private insurers.
Also known as Part C, these plans bundle the benefits of Parts A and B—and usually Part D—into a single policy. Many plans also include additional services such as dental, vision, or hearing coverage.
At first glance, Medicare Advantage plans can appear less expensive. But the details matter, and it’s wise to evaluate how each option works before making a decision.
8 Questions to Ask Before Choosing a Medicare Advantage Plan
1. What are the benefits of Medicare Advantage?
Many retirees appreciate the simplicity of an all-in-one plan. Medicare Advantage policies often feature lower monthly premiums than combining Original Medicare with a Part D plan and a Medigap policy.
Another appealing feature is the annual out-of-pocket spending cap. In 2026, the maximum for in-network services under Parts A and B is $9,250, although individual plans may set lower limits. Once you reach that threshold, the plan generally covers 100% of eligible costs for the remainder of the year.
Many plans also include benefits not offered under Original Medicare, such as dental, vision, or hearing services. Some insurers provide additional perks like wellness programs, nutrition support, limited in-home care services, or home safety modifications that help older adults remain independent.
2. How much do these plans cost?
Costs vary widely depending on where you live, the insurer you choose, and the plan’s features. Each policy has its own premiums, deductibles, copayments, and annual spending limits.
Because these details can change from year to year, it’s important to review plan updates annually during open enrollment.
3. Why do some plans advertise $0 premiums?
Low or zero-premium plans often come with trade-offs. Most Medicare Advantage policies operate within a defined network of doctors, hospitals, and pharmacies. In many cases, you’ll also need referrals to see specialists.
If your preferred physicians are outside the plan’s network, you may need to switch providers or consider a different coverage option.
4. Do I still pay the Medicare Part B premium?
Yes. Even if you enroll in a Medicare Advantage plan, you must still pay the standard Part B premium, along with any applicable Income-Related Monthly Adjustment Amount (IRMAA). If your plan includes prescription coverage, IRMAA could also apply to Part D.
Under Medicare Advantage, the federal government pays insurers a set monthly amount to manage your care. The insurer then pays doctors and hospitals based on negotiated rates. Under Original Medicare, payments go directly from Medicare to the healthcare provider, while a Medigap policy can help cover remaining patient costs.
5. What if I split my time between two homes?
Coverage depends on the plan. Medicare Advantage policies usually rely on regional provider networks. If you live part of the year in different states, you’ll need to confirm whether your insurer maintains networks in both areas.
Some large carriers do offer multi-state access, but not all plans provide that flexibility.
6. How does coverage work while traveling?
Emergency care is covered nationwide under both Original Medicare and Medicare Advantage. Routine or non-emergency care, however, may not be covered outside your network area.
If you travel frequently—especially internationally—you may want to consider separate travel insurance or medical evacuation coverage.
7. Can premiums increase?
Yes. Insurers typically review pricing annually and may adjust premiums, copayments, or other plan details. If changes occur, you’ll be notified before the next coverage year begins. The Social Security Administration will also inform you if your Part B premium or IRMAA amount changes.
8. Can I switch back to Original Medicare later?
You can move between Medicare Advantage plans or return to Original Medicare during the annual open enrollment period. However, if you later decide to add a Medicare Supplement policy, you may need to undergo medical underwriting.
Depending on your health status, the insurer could charge higher premiums or even deny coverage. For that reason, some retirees consider whether a Medigap policy makes sense during their initial Medicare enrollment window.
Steps to Compare Your Medicare Options
Making Medicare decisions can feel complicated, but a structured approach can help:
● Use Medicare’s Plan Finder tool to compare Advantage plans available in your area.
● Evaluate the total costs of Medicare Advantage versus Original Medicare plus a Medigap policy.
● Review how provider networks might affect your access to doctors and hospitals.
● Ask your physicians which plans they accept and recommend.
Don’t Forget to Check With Your Employer
There may be additional options available if you’re retiring from a company that offers retiree benefits.
Feinschreiber suggests contacting your employer around age 64 to learn about potential coverage. Some employers or unions provide Medicare Advantage plans for retirees and may negotiate lower premiums or contribute toward the cost.
In many cases, retirees can choose either the employer-sponsored option or another plan available in the marketplace.
Think About Long-Term Healthcare Needs
Choosing coverage when you’re healthy can be challenging because it’s difficult to predict future medical needs. It can help to ask insurers how their plans work in more complex scenarios—such as managing chronic illnesses or covering major procedures later in life.
Planning for those possibilities today can help prevent unpleasant surprises later.
Common Medicare Advantage Pitfalls to Avoid
Focusing only on low premiums
A plan with little or no monthly premium may still involve higher copayments, deductibles, or out-of-network costs. Always review the full policy details.
Overlooking network restrictions when traveling
Emergency care is covered anywhere, but routine services often must occur within the plan’s network.
Assuming coverage works in multiple states
If you split time between locations, confirm your plan operates in both regions.
Expecting an easy switch to Medigap later
Outside the initial enrollment window, you may face medical underwriting when applying for a Medicare Supplement plan.
Skipping prescription drug coverage
Failing to enroll in Part D when first eligible can result in a permanent penalty of 1% per month once you do enroll.
Planning for Medicare in Your Retirement Strategy
Healthcare costs play an important role in retirement planning. Decisions about Medicare should be considered alongside other major financial choices, such as when to claim Social Security and how to generate retirement income.
Mapping these costs into your retirement plan early can help you avoid surprises later. Working with a financial advisor may also help you evaluate which Medicare options best align with your long-term financial goals.
Sources:
https://www.fidelity.com/viewpoints/retirement/medicare-advantage
Disclosure:
This information is an overview and should not be considered as specific guidance or recommendations for any individual or business.
This material is provided as a courtesy and for educational purposes only.
These are the views of the author, not the named Representative or Advisory Services Network, LLC, and should not be construed as investment advice. Neither the named Representative nor Advisory Services Network, LLC gives tax or legal advice. All information is believed to be from reliable sources; however, we make no representation as to its completeness or accuracy. Please consult your Financial Advisor for further information.