You’ve reached the final installment of the “Medicare reality check" series. In Parts 1–3, readers learned what’s changing in Medicare Advantage, why risks are rising, and where coverage gaps can create surprise costs. Now we turn that insight into action — with the specific questions to ask and the strategies that can help fill gaps.
As you evaluate your options as a new Medicare enrollee, or to navigate a switch in plans, use this Medicare Advantage (MA) checklist to get the information you need for the best decision:
If your providers are in network, it will be important to find out if any of them are accepting new Medicare Advantage plan patients to ensure you can continue with them. When your providers aren’t in network, you may ask the insurer if you’re permitted to see them, assuming you’re willing to pay higher fees for those visits. Ask if services paid out of pocket, due to being out of network, count toward your maximum limit to ensure you don’t have additional costs you didn’t plan for. This is especially critical if you have an HMO plan.
Find out specific benefits of any extra coverage provided. You’ll want to know what you receive related to routine exams and if your MA plan pays toward other procedures, like tooth extractions, or needs, such as eyewear or hearing aids. You should also ask if other extras are included, such as discounts on fitness/gym membership.
When it comes to out-of-pocket costs, Medicare Advantage plans have many variables. In addition to any premiums you pay, you also have deductibles, copayments, and coinsurance. Medicare provides a checklist of considerations as you budget for these expenses.
Keep a list of your current prescription drugs to ask if they’re on your private health plan’s formulary. If so, you’ll also want to ask about pricing and if there are prior authorization requirements or limits on the drug’s quantity. Further, find out if your preferred pharmacy is in network because you may get discounted pricing on prescriptions if it is.
If you have a preferred hospital, you’ll want to learn if it’s in network. If not, you may need to find another that’s accessible for potential emergencies. You’ll also want to know what you will pay out-of-pocket, such as for daily copayments, should you need to be admitted.
Unlike Medicare Supplement plans that pair with original Medicare, many Medicare Advantage plans don’t provide coverage for emergencies while on international travel. If this is important, and an MA plan is right for you, you’ll need to seek a plan that provides it.
After you have answers, should you determine Medicare Advantage is your best decision, you should prepare for potential health care needs to best safeguard your health and finances. To fill any coverage gap, Medicare Advantage plan beneficiaries should consider supplemental insurance.
It’s unlikely that you will find an MA plan that fulfills all your needs. That’s why supplemental insurance for Medicare Advantage is available to help fill coverage gaps.
The supplemental insurance you’ll have access to with MA plans isn’t Medicare Supplement insurance (or Medigap). Instead, other policies and riders can pair with either Medicare or MA plans to meet specific health needs you have. This may be for dental services, when your MA plan doesn’t provide basic or comprehensive coverage. You could also get benefits for critical illnesses, like cancer, a heart attack, or stroke. Or, you may want to have coverage for potential hospital stays. Whatever your concern, these types of plans are designed to make it easy for you to fill coverage gaps.
Erin Bueltel, Director of Product Solutions for Wellabe, says you want to consider Hospital Indemnity insurance and its riders for how it can help pay expenses for your hospital stay.
“With Hospital Indemnity, you can pick a dollar amount that meets or even exceeds your MA copays,” she says. “For example, if you have a $350 inpatient hospital copay, you can pick a Hospital Indemnity plan that gives you $350 each day, up to a certain number of days that you also choose, to pay that copay.”
Bueltel also says Wellabe has introduced innovative technology to help its customers fill their specific Medicare Advantage coverage gaps as closely as possible. It’s a tool called MyEasyMatch.
“MyEasyMatch enables agents to effectively pair a consumer’s exact MA plan with the Hospital Indemnity insurance benefit that most closely matches the copay. This allows us to help limit the out-of-pocket costs customers would have if they needed that care,” Bueltel says. “The tool is updated every year with changes that have been made to MA plan benefits. It takes the guesswork out of filling coverage gaps.”
Bueltel adds: “Besides Hospital Indemnity insurance, we have opportunities at Wellabe to participate in value-added programs that fill coverage gaps, like those with our vision and hearing partners. Wellabe wants to be here for you for the long haul.”
You’ve now reached the end of the “Medicare reality check" series, and you have a clearer view of what’s changing, what to watch, and what to ask before costs surprise you.
If you’re reviewing coverage for 2026, the most powerful next step is to use these questions to compare plans and explore gap‑filling options that match your needs. Then contact your agent to discuss your concerns and options, especially Jan. 1-March 31, which is the MA Open Enrollment Period.
Don’t have an agent? Call 866-739-8143 or request a free quote.
View the entire “Medicare reality check” series >
Photo credit: iStock
Wellabe offers life and supplemental health insurance plans to help you prepare for good days and bad. We’ll always be here to empower you to be well — well prepared and well protected.
