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Medicare Advantage plans now cover slightly more than half of American seniors in the Medicare program. The attraction is in both the low costs and the additional services they advertise. But there can be significant drawbacks to Advantage plans since they limit covered access to physicians and hospitals in their network.

It’s up to you to become informed about the balance between additional benefits and the limitations that Advantage plans might present in the future if you need extensive medical care.

So here are a few things to consider in making the choice between traditional Medicare, with a supplement and a Part D drug program, and Medicare Advantage. If you do choose Advantage, see how to choose the best Advantage plan for you — one that includes your medical providers and covers your prescription drugs.

And if you have already chosen Advantage, here’s a reminder to do the annual review outlined below. Your Advantage plan may no longer cover your prescriptions, or it may have dropped your favorite physician from its network. Now is the time to review to make sure you get the correct coverage for 2025.

The choices made during Open Enrollment each year can seem daunting, but this is no accident. “It’s in the interest of Medicare Advantage insurers to make it as complicated as possible — so you’ll pay attention to what they say in their commercials,” says Medicare expert Phil Moeller, author of a terrific new Medicare book ("Get What's Yours for Medicare, Revised and Updated: Maximize Your Coverage, Minimize Your Costs," Simon & Schuster) and writer of the "Aging in America" newsletter. I’ve incorporated his advice below.

Cost is often the first determinant of the basic choice between Advantage and original Medicare. The Advantage plan will cost less in monthly premiums. The monthly Advantage premium includes your Part B premium (including any IRMAA increases based on income). Advantage may also give you additional “free services” such as hearing, dental and vision coverage.

How can Advantage plans afford to give this care away on such a low premium? The government subsidizes Advantage plans with a fixed dollar amount each year. In return, the insurer “manages” your care, negotiating lower costs with participating doctors and hospitals. That’s why you’re limited to a network of providers. And why they typically require pre-authorization for many services.

The Advantage plan may advertise low monthly premiums, but there are additional costs for those who go this route. You’ll have to pay out of pocket for co-payments for many visits, tests, hospital stays and even emergency room treatment! It’s important to check and compare the maximum “out-of-pocket” cost that each plan guarantees.

These are mostly public companies, expected to show a profit for shareholders. That’s why you might be denied access to specialists, or testing.

Now that you understand the potential limitations of Advantage plans, if that’s still your choice for coverage, either because of lower costs or attractive benefits for hearing, vision and dental (and sometimes things like telemonitoring services or transportation to healthcare visits), it’s time to compare plans.

The worst place to start is by responding to a robocall or late night TV commercial. The correct way to start is by asking your physician(s) what networks they participate in. They will give you a list of plans in which the are considered “in network.” You’ll want to check with your primary care physician, your specialists and your chosen hospital.

At that point, you can go to Medicare.gov and use the PlanFinder tool to search what they call “Medicare Part C” plans offered in your area. Before starting your search, you’ll want to input a list of your prescriptions and favorite pharmacies, since most Advantage plans include drugs. The PlanFinder tool will incorporate the drug coverage in your search.

You’ll immediately see at least five Advantage Plans to compare, likely based on the headline out-of-pocket cost limitation. But take a moment to read through the entire plan description, including the out-of-pocket expenses you’ll be expected to pay. Check to see how and if they cover emergency room visits or ambulance transportation.

Finally, each plan is given a starred rating by CMS (Center for Medicare Services). Avoid those with only one- or two-star ratings.

At this point, knowing that your doctors and hospitals are included, along with your prescription drugs and favorite pharmacy, and knowing the maximum you could pay if you do need unexpected healthcare in 2025, you can sign up and join the Advantage plan of choice, right from the Medicare.gov website.

You may find that your Advantage plan becomes too limiting if you become ill and want second opinions out of network. Or it may happen that your preferred hospital or your physician drops out of this particular plan. You can switch plans at open enrollment, which happens toward the end of year, and move to one that includes more of your caregivers.

But if you want to switch back to original Medicare and a supplement, you might be in for a shock. You’re guaranteed access to the best supplement — Plan G — regardless of health, only in the first six months of signing up for Medicare. But if you drop out of Advantage and want to go back to your original supplement, in most states you may be denied because of medical conditions, or may be required to pay a much higher premium for your supplement. You could switch to a lesser supplement, with more exposure to co-payments, but still get the choice of care that original Medicare provides.

One other consideration: If you travel frequently, or have a second home in a warmer climate, you likely want to stick with original Medicare and a supplement and Part D, because they will cover care by any provider who accepts Medicare.

You have until December 7 to make important decisions about your healthcare coverage for 2025. If you have an Advantage plan, your existing coverage almost certainly has changed for 2025. Doing the research now means you won’t be surprised when you need your coverage. And that’s The Savage Truth.

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(Terry Savage is a registered investment adviser and the author of four best-selling books, including “The Savage Truth on Money.” Terry responds to questions on her blog at TerrySavage.com.)

©2024 Terry Savage. Distributed by Tribune Content Agency, LLC.