10 Medicare Advantage Myths Debunked
Medicare Advantage (Part C) plans have grown in popularity over the past decade, but with that growth has come a flood of misinformation. As a licensed Medicare broker, I often hear the same misconceptions from clients and those myths can lead people to make choices that don’t best serve their needs.
Let’s set the record straight! Below are 10 of the most common Medicare Advantage myths and the facts you need to know to make informed Medicare decisions!
10 Common Medicare Advantage Myths
Myth #1: Medicare Advantage Plans Are “Free”
Truth: While many Medicare Advantage plans have a $0 monthly premium, they’re not free. You still pay your Medicare Part B premium ($185/month for most beneficiaries in 2025), which is usually deducted from your Social Security check. There may also be other out-of-pocket costs like copays, coinsurance, and deductibles depending on the plan. These plans are affordable for many, but it's important to look beyond the premium and understand your potential costs throughout the year.
Myth #2: Medicare Advantage Is a Scam or “Too Good to Be True”
Truth: Medicare Advantage plans are not scams; they are legitimate, federally funded insurance plans offered by private companies that contract with Medicare. These plans are required by law to provide at least the same level of coverage as Original Medicare (Parts A & B). Many also include extra benefits like dental, vision, hearing, gym memberships, and more. The reason they can offer these perks is that the government pays a fixed amount to the insurance company to manage your care and therefore, in competitive markets, these companies can add benefits to attract members.
Have questions about Medicare Advantage plans in Altoona, PA or other Medicare options in Blair County, PA? Tara at Care Compass provides clear, local guidance to help you choose the right coverage.
Contact Tara at Care Compass today to schedule your free, no-obligation consultation. There is NEVER a cost to use our services, and we are committed to helping you make confident, informed decisions about your healthcare coverage.
Myth #3: Original Medicare Is Always Better Than Medicare Advantage
Truth: Not necessarily. Original Medicare and Medicare Advantage work very differently, and which one is better depends on your individual needs. With Original Medicare, you can see any provider that accepts Medicare nationwide and you can add a Medigap plan to cover some of the gaps in your Medicare coverage. However, you’ll typically pay more in premiums and you’ll need to purchase a separate Part D (Rx drug) plan. Medicare Advantage plans usually have lower monthly premiums, often includes drug coverage, and bundle in “extras”, but you’ll need to work within a provider network and you may have different cost-sharing rules. It’s not about better or worse - it’s about what works best for you based on your needs.
Myth #4: Medicare Advantage Plans Are All the Same
Truth: Medicare Advantage plans vary widely by location, carrier, network, benefits, and costs. Even within the same zip code, you will find many different plans with varied provider networks, formularies (drug lists), out-of-pocket maximums, and coverage perks. That’s why it’s so important to compare plans carefully, especially based on your doctors, prescriptions, and overall healthcare needs.
Myth #5: You’re Locked In Forever Once You Choose a Medicare Advantage Plan
Truth: You are not stuck forever. There are multiple enrollment windows that allow you to make changes. The Annual Enrollment Period (Oct 15 – Dec 7 each year) lets you switch Medicare Advantage plans or return to Original Medicare and pick up a Part D (Rx drug) plan. The Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31) also allows changes if you’re already enrolled in an Advantage plan. Plus, if this is your first time on a Medicare Advantage plan and you’re within your first year, you may be eligible for a “Trial Right” that lets you return to Original Medicare and purchase a Medigap policy without medical underwriting. More on that below!
Myth #6: If I Enroll in a Medicare Advantage Plan When First Eligible, I Won’t Be Able to Get a Medigap Plan Later
Truth: When you first enroll in Medicare Part B, you get a one-time six-month Medigap Open Enrollment Period. During this time, you can enroll in any Medigap plan available in your area with guaranteed acceptance, meaning the insurance company can’t deny you coverage or charge you more based on your health. There are no medical questions or underwriting during this window.
However, if you don’t enroll in a Medigap plan during this period - for example, if you choose a Medicare Advantage plan instead - your future ability to get Medigap coverage is not guaranteed and if you apply for a Medigap plan later, you may be subject to medical underwriting, which means the insurance company can deny your application or charge a higher premium based on your health history.
However, there are circumstances where you may have a “Trial Right” to enroll in a Medigap plan with guaranteed acceptance even when outside of your Medigap Open Enrollment Period. These include:
Trial Right #1 – If you had a Medigap plan and dropped it to try a Medicare Advantage plan for the first time, you have the right to switch back to Original Medicare and join the SAME Medigap plan you had before the switch, as long as you do so within 12 months.
Trial Right #2 – If you joined a Medicare Advantage plan when you were first eligible for Medicare and within the first year of joining, you want to switch to Original Medicare, you may do so as long as it’s within 12 months of joining the Medicare Advantage plan. In this case, you have guaranteed acceptance into ANY Medigap policy available in your state without medical underwriting.
Check out “What are Medicare Advantage Trial Rights?” to learn more.
Myth #7: I Won’t Have Access to Care If I’m Outside of My Plan’s Network
Truth: While Medicare Advantage plans often have networks, emergency and urgent care are always covered, even outside your network or when you’re traveling. If you're a snowbird or regularly spend part of the year in another state, a PPO plan or Original Medicare with a Medigap policy might offer more flexibility, but if you’re just traveling occasionally or going on vacation, you’ll still be covered in case of an urgent or emergent situation. Your lifestyle and travel habits are important considerations when choosing a Medicare plan!
Myth #8: Once Enrolled in a Medicare Advantage Plan, I Don’t Need to Do Anything
Truth: Medicare Advantage plans can change every year, including the premium, copays, covered medications, provider networks, and extra benefits. Your health needs may change, too. That’s why it’s important to review your Annual Notice of Change (ANOC) each fall and double-check that your doctors and prescriptions are still covered the way you need them to be. Even if you’re happy with your current plan, taking 15–30 minutes to review each year could save you a lot of money or hassle later.
Myth #9: If I’m on a Medicare Advantage Plan, I Can See Any Doctor Who Accepts Medicare
Truth: Unlike Original Medicare, Medicare Advantage plans use networks, so you cannot see any physician just because s/he accepts Original Medicare. If you have a Medicare Advantage HMO, you usually need to see in-network providers and may need referrals to see specialists. If you have a Medicare Advantage PPO, you can go out of network, but you'll sometimes pay more for those visits. Always check with your doctors to ensure they’re in the plan’s network before you enroll. And remember, networks can change year to year.
Myth #10: I Don’t Need Help Choosing a Plan
Truth: With a myriad of plans available in many areas, each with different costs, coverage rules, provider networks, and drug formularies, it’s easy to get overwhelmed or miss something important. Working with a licensed Medicare broker (like me!) doesn’t cost you anything, and it gives you access to professional guidance tailored to your specific health needs and preferences. There are dozens of Medicare Advantage plans in Altoona, PA alone! You don’t have to do this alone and making the right choice now can save you time, money, and stress later.
Summary
As we’ve seen, there are a lot of misconceptions about Medicare Advantage. The truth is, Medicare Advantage isn’t good or bad - it’s simply one of several options available and the right choice depends on your personal needs. That’s where a Medicare broker comes in!
Choosing a Medicare plan isn’t just about picking the lowest premium or the plan with the most bells and whistles; it’s about finding the right coverage for you, based on your doctors, medications, health conditions, lifestyle, and budget and a local Medicare broker can help you navigate the complex Medicare landscape. And best of all, there is NO COST to you! If you’re looking to explore Medicare Advantage plans in Altoona, PA or the surrounding Blair County region, contact Care Compass today to schedule your NO COST consultation!
Care Compass is an independent insurance agency dedicated to helping seniors navigate the complexities of Medicare and other senior products. We provide clear, personalized guidance on Medicare Advantage plans in Altoona, PA, Medicare Advantage plans in Blair County, PA, and Medicare Advantage plans in Duncansville, PA, as well as Medicare Supplement (Medigap) plans to fit a variety of healthcare and budget needs.
Our mission is to empower Medicare-eligible individuals to make confident, informed decisions about their coverage. Whether you are comparing a Medicare Advantage plan in Altoona, PA, reviewing Medicare Supplement options in Blair County, PA, or simply need answers to your Medicare questions, we are here to help.
Our services are always offered at NO COST to you. Care Compass is proudly owned and operated in Duncansville, Pennsylvania, serving residents throughout Blair County and the surrounding communities. Contact us today to explore your Medicare options with a trusted local resource.
