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October 15 marks the start of the annual Medicare Open Enrollment Period, which runs through Dec. 7. If you have Medicare, or you’re about to qualify, it’s time to make important decisions about your coverage for 2025. This includes deciding whether you want to enroll in a Medicare Advantage plan for the first time or make changes to your current plan.
What is Medicare Advantage?
Medicare Advantage, also referred to as Part C, is one of the four parts of Medicare:
- Medicare Part A – Hospital Insurance
- Medicare Part B – Medical Insurance
- Medicare Part C – Medicare Advantage (includes Parts A and B)
- Medicare Part D – Prescription Drug Coverage
Medicare Advantage plans are private health plans that have contracts with Medicare. If you decide to enroll in one of these plans, your Medicare-covered health care services go through the private plan.
To enroll in a Medicare Advantage plan, you must be enrolled in original Medicare (Parts A & B). This is also true if you want to enroll in a Part D / Medicare prescription drug plan.
What does Medicare Advantage cover? Why do I need it?
Original Medicare covers some of the costs of services, such as hospital and skilled nursing facility stays, home health, and hospice (Part A) and doctor visits, durable medical equipment, and labs (Part B). But it doesn’t pay for everything. While Medicare Advantage plans provide the same standard coverages as original Medicare, they also offer extra benefits that can help you reach and maintain your health and wellness goals. These can include:
- Vision (eyewear), routine dental, and hearing aids
- Health club memberships
- Non-medical transportation
Some Medicare Advantage plans even cover additional non-medical benefits such as nutrition counseling and meal delivery services. These plans are designed to help you live an active and independent lifestyle where you feel socially connected to others in your community.
How do I choose the best Medicare Advantage plan for me?
Choosing a Medicare Advantage plan isn’t a one-size-fits-all scenario. That’s why it’s smart to do your homework first. Use this checklist to help you understand the options available to you and make an informed decision about your health plan.
2025 Medicare Advantage Checklist
🔲 1. Are your favorite doctors, hospitals, and pharmacies in the plan’s network?
Each Medicare Advantage plan has its own network of doctors, specialists, hospitals, and pharmacies. That’s why it’s important to check that your preferred providers are part of a plan’s network before you enroll.
🔲 2. Does your plan allow you to visit a non-network provider?
Some plans permit you to see out-of-network doctors, but you will likely pay more money out of pocket for these visits.
🔲 3. Are there prescription drugs you take regularly and does your plan cover them?
Medicare Advantage plans include original Medicare benefits and often have prescription drug coverage (Part D) as well. Find out if the specific medications you take are included under the plan you’re considering and what you will have to pay for them. For example, some Medicare Advantage prescription drug plans offer certain medications with $0 copays (depending on their drug list and drug-tier levels).
Drug lists (called formularies) can change every year, so you’ll want to check annually whether your prescription medications are still covered under your plan and what you will have to pay for them.
🔲 4. Do you enjoy being active and exercising? Would a fitness benefit interest you?
In addition to extra benefits like dental, vision, and hearing, many Medicare Advantage plans offer fitness programs for older adults, such as SilverSneakers®. These programs can help you make physical activity part of your everyday life.
🔲 5. How much does your plan cost, and does it fit your budget?
Several factors determine Medicare Advantage out-of-pocket (OOP) costs, such as premiums, deductibles, copayments, and coinsurance. These costs may vary based on the plan you choose. Your costs also will be decided by how often you need medical services, and whether you see any specialists in addition to your primary care provider.
In 2025, Medicare Advantage premiums are projected to range between $0 and $240+, with the estimated average plan costing $17 per month. These plans have a yearly cap on how much you’ll pay out of pocket. The out-of-pocket maximum for Medicare Advantage plans in 2025 is $9,350 (but some plans set lower limits).
🔲 6. Are there programs available to help you with Medicare out-of-pocket costs?
Medicare can help cover some medical- and health-related costs, but it's not free. If you need helping paying your Medicare out-of-pocket costs, look at the income guidelines for available assistance programs and apply if you think you might qualify.
If you have special health care needs, you might consider a Medicare Special Needs Plan (SNP), which is a type of Medicare Advantage plan. Some people are eligible for both Medicare and Medicaid and can enroll in a Dual-Eligible SNP (D-SNP). Those who qualify are either older adults with low income or people living with a disability or end-stage renal disease.
🔲 7. Would non-traditional benefits, such as transportation and food delivery services, be helpful to you?
Some Medicare Advantage plans offer other non-medical benefits, such as:
- Help with utility costs
- Access to and assistance with buying healthy foods
- An allowance toward over-the-counter items via a Medicare flex card
- Fall prevention aids
- Companionship
If these types of services would make your life easier, it may be a good idea to find Medicare Advantage plans that include them.
Medicare Advantage enrollment and next steps
There are many factors to consider when choosing a Medicare Advantage plan. With a little research up front, you’ll be able to select the plan that’s a good fit for your health care needs, lifestyle, and budget.
Once you’ve identified the Medicare Advantage plan that meets your needs, it’s time to enroll and make your initial premium payment. Remember that there are limited periods during which you can enroll (and disenroll) from a private Medicare Advantage health plan. Avoid paying a late penalty fee by taking note of when the enrollment window is open.
Talk to a licensed advisor that meets our Standards of Excellence
Need help sorting through all your Medicare options? For more personalized, one-on-one advice, consider connecting with a licensed Medicare specialist. The brokers we work with are thoroughly trained and certified to meet NCOA’s exclusive Standards of Excellence. These standards help ensure our partners are highly knowledgeable in all things Medicare—and that they provide consumer-focused guidance that is impartial, practical, and 100% confidential.
