4 Myths about Medicare Advantage

Getting ready to choose a Medicare plan? Put these misunderstood Medicare Advantage facts to rest.

When shopping for a Medicare plan, a Medicare Advantage plan (Part C) is one of several options you'll have to choose from. These choices can be confusing, so we’re here to tell you the truth behind common myths around Medicare Advantage. Then you can find your best plan — and feel confident with your choice.

Myth 1: Provider networks are limited

With some Medicare Advantage plans, you can see any provider in any network. Through certain plans, you can generally see any provider you’d like, but you may be charged less if you see a doctor in your health plan’s network. These plans include:

Preferred Provider Organizations (PPO)
Health Maintenance Organizations Point of Service (HMOPOS)
Provider Fee-for-Service (PFFS)

With a Health Maintenance Organization (HMO) plan, your provider network may be defined. If your doctor stops accepting Medicare or leaves the network, you’ll be notified and you can choose a different provider.

To find out if your doctor or hospital is included in your Medicare Advantage plan’s provider network, you can either check with them directly or visit your health plan’s website, where you can search your doctor by name to see if they’re in your covered network.

Myth 2: Referrals are needed for specialty services

In most cases, you won’t need a referral to see a specialist with a Medicare Advantage plan. If you have a PPO or PFFS plan, you will not need one.

You’ll need a referral if you have an HMO Plan or a Special Needs Plans (SNP), except for certain yearly screenings, such as routine mammograms.

Myth 3: Once you enroll in a Medicare Advantage plan, you can’t switch to a different plan

If you enroll in a Medicare Advantage plan and find that it isn’t meeting your needs, you can switch your plan during the yearly Medicare Open Enrollment. The dates for these enrollment periods may change every year, so check medicare.gov to make sure you’re ready for the next one.

If you don’t enroll during the Annual Enrollment Period, you may be eligible to enroll in or change your Medicare Advantage plan during a Special Enrollment Period. You can qualify for special enrollment periods due to life events such as losing health insurance coverage, moving to a different state or county, entering a long-term care facility or getting married.

Myth 4: Medicare Advantage is only available through the federal government

Medicare is a federal health insurance program for people age 65 and older.

Original Medicare is made up of Medicare Parts A and B, which are provided through the government.
Medicare Part C, known as a Medicare Advantage plan, like Geisinger Gold, is offered through health insurance companies like Geisinger Health Plan, as are Part D prescription plans.

Each part covers different services and comes at different costs.

Geisinger Gold Medicare Advantage plans, made for you

Medicare Advantage plans like Geisinger Gold include your hospital, medical and prescription drug coverage, all in one. Geisinger Gold also offers additional benefits, like vision and dental coverage.

Interested in learning more? Geisinger Gold Medicare advisors are standing by and are ready to help you on your Medicare journey. Call us for more information at 800-482-8163 (TTY: 711).