More About Medicare Advantage Plans (Medicare Part C)

As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.

■ Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.

■ You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.

■ You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease.

■ You can only join a plan at certain times during the year. In most cases, you are enrolled in a plan for a year.

■ If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.

■ If the plan decides to stop participating in Medicare, you will have to join another Medicare health plan or return to Original Medicare.


■ You usually get prescription drug coverage (Part D) through the plan. If you are in a Medicare Advantage Plan that includes prescription drug coverage and you join a Medicare Prescription Drug Plan, you will be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

■ You don’t need to buy (and can’t be sold) a Medigap (Medicare Supplement Insurance) policy while you are in a Medicare Advantage Plan. It won’t cover your Medicare Advantage Plan
deductibles, copayment, or coinsurance.