Medicare Advantage vs Medicare plan F questions

 Here is the full updated list of questions to ask a health insurance broker, along with clear, predictable answers for a 78-year-old female with polymyositis considering switching from Medicare Advantage to Medicare Plan F:

### Questions with Predictable Answers for the Broker Meeting

1. **Am I eligible to enroll in Medicare Plan F?**  

   - *Answer:* Yes, if you became eligible for Medicare before January 1, 2020. Otherwise, you cannot enroll in Plan F.[2][9]

2. **Will my polymyositis preexisting condition affect enrollment or premiums?**  

   - *Answer:* Outside your initial enrollment period, medical underwriting may apply. This could mean higher premiums or denial unless you have guaranteed issue rights, such as switching from Medicare Advantage.[9][10]

3. **How do Plan F and Medicare Advantage differ in coverage for my monthly infusion treatments?**  

   - *Answer:* Plan F covers 100% of Medicare Part B costs for infusions, resulting in no copays or deductibles for these treatments. 

Medicare Advantage requires copays and coinsurance, possibly leading to high out-of-pocket infusion costs.[11][12]

4. **What are the differences in provider access and network restrictions?**  

   - *Answer:* Plan F lets you see any doctor or facility that accepts Medicare without referrals or network limits. Medicare Advantage typically restricts you to a provider network and requires prior authorizations or referrals.[1][3]

5. **What are the total expected costs for each plan including premiums and out-of-pocket expenses?**  

   - *Answer:* Plan F has higher premiums ($170–$198/month) but minimal out-of-pocket costs outside premiums. Medicare Advantage has lower premiums (often under $20/month) but variable and potentially high out-of-pocket costs, particularly with frequent infusions.[13][11]

6. **Are prescription drugs, dental, vision, and hearing included?**  

   - *Answer:* Plan F does not include drug or dental/vision coverage. Those require separate plans. Medicare Advantage plans usually include prescription drugs and some dental, vision, and hearing benefits.[5][11]

7. **What are the annual out-of-pocket costs I can expect with each plan?**  

   - *Answer:* Plan F generally has no annual out-of-pocket costs for Medicare-covered services beyond premiums and separate drug/dental coverage premiums. Medicare Advantage plans have copays and coinsurance capped by an annual out-of-pocket maximum (up to $9,350 in 2025), which can lead to significant expenses in high-use years.[12][14][15][2]

8. **How does travel coverage compare between the two plans?**  

   - *Answer:* Plan F offers nationwide coverage with access to any Medicare provider. Medicare Advantage is typically limited to in-network providers within a service area, with limited or no coverage outside that area.[1]

9. **What are the enrollment periods and flexibility for switching between plans?**  

   - *Answer:* Plan F can be applied for any time but may require medical underwriting except during guaranteed issue periods. Medicare Advantage has an Annual Election Period (Oct 15–Dec 7) for changing plans or switching back to Original Medicare with Medigap.[11][1]

10. **Which companies offer the best Plan F options in North Carolina?**  

    - *Answer:* Leading Plan F providers include Blue Cross Blue Shield of North Carolina, Humana, UnitedHealthcare/AARP, and Cigna. Premiums and customer service can vary, so comparing options is advised.[16][17]

***

This comprehensive question and answer set provides the necessary insights to evaluate the trade-offs between the predictable, broad coverage of Plan F versus the lower premiums but network limitations and potential high out-of-pocket expenses of Medicare Advantage, particularly for someone with polymyositis requiring frequent infusions.[2][5][1][11]

Sources

[1] Medicare Advantage vs. Medicare Supplement: Difference in 2025 https://medigapseminars.org/differences-between-medicare-advantage-and-medigap/

[2] Compare Medigap Plan Benefits | Medicare https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits

[3] Medigap vs. Medicare Advantage: What's the Difference? - NerdWallet https://www.nerdwallet.com/article/insurance/medicare/medigap-vs-medicare-advantage

[4] The Big Choice: Original Medicare vs. Medicare Advantage - AARP https://www.aarp.org/medicare/original-medicare-vs-advantage/

[5] Medicare Advantage vs. Medicare Supplement Plans - Investopedia https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp

[6] [PDF] Choosing a Medigap Policy - Medicare https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf

[7] The best Medicare supplement plans in 2025 - MedicalNewsToday https://www.medicalnewstoday.com/articles/best-medicare-supplement-plans

[8] Medicare Supplement vs. Medicare Advantage | Anthem https://www.anthem.com/medicare/learn-about-medicare/medicare-supplement-vs-medicare-advantage

[9] Your Guide to Medicare Supplement Enrollment Periods https://themedicarefamily.com/medicare-supplements/medicare-supplement-enrollment-periods/

[10] When can I buy a Medigap policy? - Medicare https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy/when

[11] What Is the Difference Between Medicare Advantage and Medigap? https://www.ncoa.org/article/what-is-the-difference-between-medicare-advantage-and-medigap/

[12] Medicare Plan F Cost in 2025 - Healthline https://www.healthline.com/health/medicare/medicare-part-f-cost

[13] Best North Carolina Medicare Supplement Plans (2025 Rates) https://www.moneygeek.com/insurance/health/best-medicare-supplement-north-carolina/

[14] What You'll Pay in Out-of-Pocket Medicare Costs in 2025 https://www.ncoa.org/article/what-you-will-pay-in-out-of-pocket-medicare-costs-in-2025/

[15] What You Will Pay for Medicare in 2025 - Kiplinger https://www.kiplinger.com/retirement/medicare/what-you-will-pay-for-medicare-in-2025

[16] Sign up for Medicare in Hendersonville, NC for 2026 https://north-carolina.medicaresignups.com/medicare-in-hendersonville-nc

[17] Medicare Supplement Insurance Plan F - Humana https://www.humana.com/medicare/medicare-supplement-plans/plan-f