Congratulations! You successfully navigated enrollment and chose a new Medicare Advantage (MA) plan. Now you have insurance with the benefits of Medicare Part A and Part B, and a host of new benefits to explore. It’s a big step — and one to be proud of.

To make the most out of your plan, we’ve created a Medicare Advantage new member checklist you can follow after enrolling in Medicare Advantage:

1. Confirm the essentials
2. Double-check your coverage
3. Learn the rules
4. Understand your other benefits

Let’s dive into the details.

1. Confirm the essentials

When getting started with Medicare Advantage, begin with the essentials: Medicare cards, accounts, and covered services. 

Every Medicare enrollee gets a red, white, and blue card with their unique Medicare ID number. As an Medicare Advantage beneficiary, you’ll receive a separate, additional ID card to use when getting covered services. This card comes in the mail with the rest of your welcome packet about two weeks after you enroll.

Also, register for an account with your insurance carrier and download their app to your phone for quick access to your account information. Your broker — if you worked with one — may also send a welcome kit and have a customer portal that shows all your plan info in one place. Be sure to list your primary care physician in your profiles. 

Unless you’re switching from Original Medicare to MA during annual enrollment, you’re entitled to a free welcome visit within the first 12 months of getting started with Medicare Advantage. You can also schedule your first Annual Wellness Visit — a care appointment where you develop a personalized prevention plan with your physician. 

2. Understand your plan’s network rules

It’s important to know the rules before using your new Medicare plan. Unlike Original Medicare, which allows you to see any doctor that accepts Medicare assignment, Medicare Advantage plans are often limited to networks.

Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, for example, have different limits for in-network and out-of-network care. Both have a network of providers, but HMOs don’t offer out-of-network coverage for non-emergency care, while PPOs offer some out-of-network coverage, but at a higher cost. These plan types also have different rules for seeing a specialist (e.g., HMOs require a referral from your primary care provider, but PPOs don’t), so confirm with your carrier which rules apply to you.

Additionally, take extra care to understand the rules for prior authorization. For many MA plans, enrollees need prior authorization before seeing a specialist, going to an out-of-network provider, or getting a high-cost procedure. Visit your carrier’s website to see a list of procedures and services that require prior authorization.

3. Verify your coverage and providers

You likely did your due diligence researching and signing up for a Medicare Advantage plan that works for you. Now that you’re officially enrolled, double-check that your preferred doctors, hospitals, and pharmacies are in-network and that your drug formulary covers your medications.

You can use your carrier’s online portal to verify coverage and locate your chosen providers. Most portals have a search engine you can use to find specialists and other in-network providers nearby. Additionally, Medicare’s Plan Finder offers an MA provider directory that allows enrollees to check if their preferred physician or hospital is in-network.

4. Know your benefits beyond basic coverage

One clear advantage that MA plans have over Original Medicare is the range of benefits available. As a beneficiary of a Medicare Advantage plan, you may be eligible for additional benefits like vision, dental, or even assistance with groceries.

Before you start using your new Medicare plan, confirm your benefits:

• What preventive care services are covered?
• If you have dental coverage, which surgeries are covered — preventive, elective, emergency, etc?
• If you have vision coverage, how often can you get new glasses?
• Are hearing exams, services, and/or devices included in your plan?
• What additional benefits are included (e.g., gym membership, over-the-counter allowance, etc), if any?

If you’re on a Special Needs Plan (SNP), you may have access to benefits that specifically cover care for your condition. For example, many SNP enrollees may qualify for or have access to Special Supplemental Benefits for the Chronically Ill (SSBCI). These can include transportation, pest control, home modification, and access to community or plan-sponsored programs and events. Review your plan to see which benefits are covered.

Before you can take full advantage of the benefits included in your MA plan, you have to know what they are. That’s why it’s important to sign up for online accounts, secure your ID card(s), know the rules of your plan, and double-check your coverage right after enrolling in a plan. This way, you can avoid surprises and make the most out of your new plan.

If you need additional support navigating Medicare Advantage as a new plan holder, a SmartMatch licensed insurance agent is available to help.