Key Points
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Since Medicare Advantage plans vary from one to another, it is important to know the rules of your plan.
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Understand your costs and benefits.
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Know which providers you can use, and recognize that you have an out if you are not satisfied with your coverage.
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Once you turn 65, you are eligible to get health coverage through Medicare. But you don’t necessarily have to stick with original Medicare.
Many seniors choose to enroll in a Medicare Advantage plan instead of original Medicare. And there can be different benefits to doing so.
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For one thing, Medicare Advantage plans commonly offer benefits beyond what original Medicare pays for. Medicare Advantage plans also place a limit on annual out-of-pocket spending. At a time when you may be on a tight budget of Social Security benefits and modest retirement plan withdrawals, this is huge.
But while Medicare tends to have the same rules for all enrollees, Medicare Advantage varies from plan to plan. So whether you’re on a new plan or you’re enrolled in the same plan you had in 2025, it’s important to know what your coverage entails and what rules you need to follow this year. Here are four things to keep in mind.
1. What your costs involve
Medicare Advantage plans can change from year to year, which means your costs can go down or up. It is important to know what costs you are looking at in terms of premiums, deductibles, and copays so that you can budget accordingly.
Keep in mind that even if you’re on Medicare Advantage, you still have to pay for Medicare Part B every month. Some Medicare Advantage plans, however, cover that Part B premium for enrollees.
2. What your provider’s network looks like
One disadvantage of Medicare Advantage plans is that they limit enrollees to a specific provider network. With original Medicare, you can see any doctor in the country that accepts Medicare.
Be sure to familiarize yourself with your plan provider’s network, as going out of network can leave you with very expensive costs. And also don’t assume that if your provider was in the network last year that it will be the same this year. Medicare Advantage plan networks can change every year.
3. What supplementary benefits are you eligible for
Another perk of signing up for Medicare Advantage is that these plans commonly offer supplemental benefits beyond what original Medicare pays. You will often find that Medicare Advantage plans pay for dental care, eye exams, and hearing aids, for example, while original Medicare will not cover these services.
Some Medicare Advantage plans offer even more benefits, such as house cleaning and grocery delivery services. It’s worth seeing what extra benefits your plan comes with. But before you get too excited about those benefits, you need to check the eligibility rules.
Your Medicare Advantage plan may offer meal delivery — but only if you have a medical condition that can be managed with changes in your diet. And your plan may offer home cleaning — but only if you have asthma or a similar condition where cleaner air can lead to better lung health based on a diagnosis you’ve received.
4. What options do you have to switch your cover
At this point, it may be too early in the year to be enrolled in your Medicare Advantage plan. But if you realize in the coming weeks that you chose the wrong plan or should have made a change during open enrollment last fall, all is not lost.
Medicare Advantage has its special open enrollment period that runs from January 1 to March 31 each year. During this window, you can switch to a different Medicare Advantage plan if your current one doesn’t seem to be working. You can also drop Medicare Advantage and go on original Medicare.
Get a handle on your Medicare coverage early
Health care can be one of your biggest expenses as a retiree. And your specific Medicare Advantage plan probably plays a role in how much you spend on it.
Be sure to familiarize yourself with your plan’s rules, costs and benefits early in the year so you can make the most of your coverage and avoid unwanted surprises. And remember, you’re not necessarily stuck with your plan for the duration of 2026, so don’t hesitate to make a change if there’s an obvious aspect of your plan that you’re not happy with.
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4 Things You Need to Know About Your Medicare Advantage Plan in 2026 was originally published by The Motley Fool