5 Medicare Advantage Plan Mistakes You Must Avoid

medicare advantage plan mistakes

Have you ever made the mistake of not reviewing Medicare Advantage plan details? Common Medicare Advantage plan mistakes include not paying your premiums, registering for the incorrect coverage, missing your initial enrollment period, and presuming your spouse is covered. Because Medicare Part C is so intricate, it’s important to pay attention to these mistakes. 

In this post, we’ll share with you essential tips to avoid Medicare Advantage plan mistakes and how we can help you choose the right coverage for your unique needs.

Common Medicare Advantage Plan Mistakes You Must Avoid

Insurance beneficiaries may make some common mistakes when selecting or using Medicare Part C plans. However, these plans can be a valuable option for individuals looking to maximize their Medicare benefits. By taking proactive steps to avoid common Medicare Advantage Plan mistakes, beneficiaries can make more informed decisions about Part C coverage. Additionally, consulting with an insurance broker or advisor can provide personalized guidance based on individual needs and preferences.

Here are five of those mistakes and how to avoid them:

Not Reviewing Plan Details Annually

One common mistake is failing to review the details of your Medicare Advantage plan annually during the open enrollment period. Plans can change their coverage, costs, and provider networks from year to year, so it’s essential to ensure that your current plan still meets your needs. To avoid this mistake, review the Annual Notice of Change (ANOC) sent by your plan provider and compare it with other available options during the open enrollment period.

Overlooking Network Restrictions

Medicare Part C plans often have provider networks, meaning you may need to see doctors and specialists within the plan’s network to receive full coverage. One mistake is choosing a plan without checking if your preferred healthcare providers are in-network. To avoid this, always verify that your doctors, hospitals, and other healthcare providers are part of the plan’s network before enrolling.

Ignoring Prescription Drug Coverage

Many Medicare Part C coverage includes prescription drug coverage (Part D), but the formularies (lists of covered medications) can vary significantly between plans. Some beneficiaries may make the mistake of not thoroughly reviewing the drug formulary to ensure that their medications are covered at an affordable cost. To avoid this, review the plan’s formulary and confirm that your medications are covered, considering copayments, coinsurance, and coverage restrictions.

Not Considering Additional Benefits

Medicare Part C often offers additional benefits beyond what Original Medicare covers, such as dental, vision, hearing, and wellness programs. Some beneficiaries may overlook these extra benefits and opt for a plan solely based on its premium cost or coverage of essential services. To avoid missing out on valuable benefits, carefully review the additional benefits offered by each plan and consider how they align with your healthcare needs.

Failing to Understand Cost-Sharing Responsibilities

Another common mistake is not fully understanding these out-of-pocket costs and how they may vary depending on the services you use. To avoid surprises, carefully review the plan’s summary of benefits to understand your cost-sharing responsibilities for different types of healthcare services. Additionally, consider your budget and healthcare needs when comparing plans to find one that offers reasonable costs for the care you anticipate needing.

What Are the Advantages of Enrolling Medicare Advantage Plans with AHG Brokers?

Enrolling in a Medicare Advantage plan can offer beneficiaries enhanced coverage, coordinated care, cost savings, additional benefits, convenience, and flexibility compared to Original Medicare alone. However, it’s essential for individuals to carefully evaluate plan options based on their unique healthcare needs, budget, and preferences before making a decision.

Here’s how AHG Brokers can guide you into choosing Medicare Part C coverage and protection:

  • Comprehensive Coverage — Medicare Advantage plans often provide coverage beyond Original Medicare (Parts A and B), including prescription drugs (Part D), dental, vision, hearing, and wellness programs. This comprehensive coverage can help reduce out-of-pocket expenses for various healthcare services.
  • Coordination of Care — Many Medicare Part C plans offer coordinated care through provider networks, health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Coordinated care can help ensure that beneficiaries receive integrated healthcare services, leading to better management of chronic conditions and overall health outcomes.
  • Cost Savings — Medicare plans typically have out-of-pocket cost limits, which can provide financial protection for beneficiaries against high medical expenses. Additionally, some plans may offer lower premiums compared to purchasing separate Medicare Part A, Part B, and Part D plans, resulting in potential cost savings for enrollees.
  • Additional Benefits — Medicare Part C often includes extra benefits not covered by Original Medicare, such as gym memberships, transportation to medical appointments, over-the-counter health products, and telehealth services. These additional benefits can enhance the overall value of the plan and improve beneficiaries’ access to essential healthcare services.
  • Convenience — Medicare Part C coverage may offer added convenience by combining Medicare Parts A, B, and D coverage into a single plan, simplifying the administrative process for beneficiaries. Additionally, many plans provide online tools and resources for managing healthcare benefits, scheduling appointments, and refilling prescriptions, making it easier for enrollees to navigate their healthcare.
  • Flexibility — Some Medicare Part C plans allow beneficiaries to choose from a variety of healthcare provider networks, giving them the flexibility to select doctors, specialists, and hospitals that best meet their needs. This flexibility can be particularly beneficial for individuals who have established relationships with specific healthcare providers or who require specialized care.
medicare advantage plan mistakes

Medicare Advantage Plan Mistakes FAQs

How do I ensure my preferred doctors are in-network with my Medicare Advantage plan?

Verify in-network doctors by contacting the plan, checking their online directory, or asking doctors’ offices. It’s crucial to confirm network participation to avoid unexpected charges for out-of-network services.

What should I do if my Medicare Advantage plan does not cover my prescription medications?

If your plan doesn’t cover your medications, discuss alternatives or request a formulary exception with your provider. In some cases, it may be necessary to consider switching to a different plan that better covers your medications.

How can I estimate my out-of-pocket costs with a Medicare Advantage plan?

You can estimate your out-of-pocket costs by reviewing the plan’s summary of benefits, including premiums, deductibles, copayments, and coinsurance rates. Additionally, consider your typical healthcare usage and any anticipated expenses when comparing plans.

What resources are available to help me navigate Medicare Advantage plan options?

Several resources can assist you in understanding and selecting Medicare Advantage plans, including Medicare’s official website, State Health Insurance Assistance Programs (SHIPs), and independent insurance agents or brokers specializing in Medicare. These resources can provide personalized guidance and answer specific questions about plan options and coverage.


As an insurance policyholder, understanding your policy’s coverages, premiums, deductibles, and key details is crucial. At AHG Brokers, our expert insurance broker will guide you through the process of choosing the right coverage. If you have questions about common Medicare Advantage plan mistakes, we’re ready to assist you. Contact us today.

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