5 Things You Should Know Before Switching to a Medicare Advantage Plan

You've got Original Medicare, but you're still paying for a lot on your own. Your coverage has some pretty big gaps, including dental and vision care, and if you want help paying for those expenses, you'll need to buy yet another policy that comes with its own set of costs.

You've thought about switching to a Medicare Advantage plan so you only have one policy to deal with. But before you make that call, it's important to understand the following five things about Medicare Advantage plans.

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1. You'll limit the doctors and hospitals you can use

Private health insurers offer Medicare Advantage plans, and they typically require you to use doctors within their network for non-emergency care. Some may permit you to use out-of-network doctors, but you'll pay a higher rate if you do. This is different from Original Medicare, which allows you to visit any doctor in the U.S. who accepts Medicare.

If you travel often or if your preferred doctor isn't part of the Medicare Advantage plan's network, you might prefer to stick to Original Medicare and add a Medicare supplement (Medigap) policy to fill in some of the gaps.

2. You'll likely need a referral to see a specialist

Original Medicare typically doesn't require you to get a referral from your primary care doctor before you can visit a specialist. However, many Medicare Advantage plans do. If this is a concern for you, check with the insurer issuing the policy to find out how it handles specialist visits.

3. You'll only have one set of costs to worry about

When you enroll in Original Medicare, you typically have to add a Part D plan for prescription drug coverage and you may want a Medigap policy to cover additional services. However, these other policies come with their own premiums, deductibles, and copays that can be difficult to keep track of.

Medicare Advantage plans include everything that Original Medicare covers, plus some extras. This often includes prescription drug coverage, so there's no need for a separate Part D plan. You'll only have one set of costs to keep track of if you choose this option.

You should also note that you won't have the option to purchase a Medigap policy if you choose a Medicare Advantage plan. So make sure your Medicare Advantage plan covers all the key services and treatments you expect to need.

4. You'll have a yearly limit on out-of-pocket costs

Original Medicare doesn't place any limit on how much you can pay in total out-of-pocket costs during the year. This could make it a costly option for those who expect to visit the doctor often in 2026.

A Medicare Advantage plan will limit your yearly out-of-pocket costs, though each plan sets its own ceiling. Check into this before settling on a Medicare Advantage plan.

5. You likely still won't have coverage for foreign travel

Most Medicare Advantage plans don't cover health insurance outside of the U.S. You'll need to look into travel medical insurance for this. Or, if you plan to retire abroad, you can check out health insurance in the country you plan to retire in.

Review all your options carefully

It's worth comparing all your options before deciding which plan is right for you. Look at coverage as well as cost. Make sure the plan you choose covers the doctors, services, and medications you need.

Do this before the open enrollment period ends on Dec. 7, 2025. If you miss this window, you may not be able to change your plan again until next October.

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