Once you turn 65, you're eligible to get health coverage through Medicare. But you don't necessarily have to stick with original Medicare.
Many seniors opt 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 will pay for. Medicare Advantage plans also put a cap 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, that's huge.
But whereas Medicare tends to have the same rules for all enrollees, Medicare Advantage differs from one plan to the next. 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 have to follow this year. Here are four things to keep in mind.
1. What your costs entail
Medicare Advantage plans can change from year to year, which means your costs could go down or up. It's important to know what costs you're looking at in terms of premiums, deductibles, and copays so you can budget accordingly.
Keep in mind that even if you're on Medicare Advantage, you're still required to pay for Medicare Part B each month. Some Medicare Advantage plans, however, cover that Part B premium for enrollees.
2. What your provider network looks like
One drawback of Medicare Advantage plans is that they limit enrollees to a specific provider network. With original Medicare, you can pretty much see any doctor in the country that accepts Medicare.
Make sure to get familiar with your plan's provider network, since going out of network could leave you with very expensive costs. And also don't assume that if a provider of yours was in-network last year that it will be the same this year. Medicare Advantage plan networks can change annually.
3. What supplemental benefits you're eligible for
Another perk of signing up for Medicare Advantage is that these plans commonly offer supplemental benefits beyond what original Medicare pays for. You'll often find that Medicare Advantage plans pay for dental care, eye exams, and hearing aids, for example, whereas original Medicare won't cover these services.
Some Medicare Advantage plans offer even more benefits, like home cleaning services and meal delivery. It pays to see what extra benefits your plan comes with. But before you get too excited about those benefits, you'll need to check on eligibility rules.
It may be that your Medicare Advantage plan offers meal delivery -- but only if you have a medical condition that can be managed by changes to your diet. And your plan might offer home cleanings -- but only if you have asthma or a similar condition where cleaner air could lead to better lung health based on a diagnosis you've received.
4. What options you have for switching your coverage
At this point, it may be too early in the year to be fed up with your Medicare Advantage plan. But if you realize in the coming weeks that you've chosen the wrong plan or should've made a switch during open enrollment last fall, all isn't lost.
Medicare Advantage has its own special open enrollment period that runs from Jan. 1 through March 31 every year. During this window, you can switch to a different Medicare Advantage plan if your current one doesn't seem to be working out. You can also dump Medicare Advantage and move onto original Medicare.
Get a handle on your Medicare coverage early on
Healthcare may 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.
Make sure to acquaint yourself with your plan's rules, costs, and benefits early on 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 switch if there's a glaring aspect of your plan you're unhappy with.
