Depending on where you live, you can choose from a dozen or more plans. Medicare Advantage (MA) plans are offered by many private companies, and these plans are not all the same. How do you know which one is best for you?
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You may have noticed that there are many Medicare Advantage (MA) plans to choose from. Depending on where you live, you can choose from a dozen or more plans. Medicare Advantage (MA) plans are offered by many private companies, and these plans are not all the same. How do you know which one is best for you?
Things to Consider When Choosing a Medicare Advantage Plan
Let’s first look at what is a Medicare Advantage plan? It is a plan run by private insurance companies as an alternative to the government-run Original Medicare. All MA plans (also known as Medicare Part C) must include hospital and outpatient medical coverage corresponding to Medicare Parts A and B. In addition, many MA plans have other benefits, such as prescription drug coverage, health and fitness plans, and dental, eye, and hearing benefits.
These additional benefits, along with their costs and specific rules, vary by plan. So, it’s a good idea to compare Medicare Advantage plan details before choosing.
Many people believe that Medicare Advantage monthly plan premiums can be low (as low as $0) and consider it important. But don’t be fooled just because of this zero monthly plan premium. You should check what the total cost of the plan over the course of the year is likely to be, including what you will spend on:
– Monthly plan premium
– Copayments and/or coinsurance (as a percentage of cost of service)
– Maximum annual out-of-pocket expenses, which may vary for in-network or out-of-network care programs
You may find that MA plans with higher monthly plan premiums are generally more affordable. Also, cost is not the only factor that can be compared. You should also consider your own unique health conditions and needs, and the value of additional benefits compared to those Medicare Advantage plans you are considering.
Questions to Consider When Comparing Medicare Advantage Plans
First, check out the Medicare Advantage plan benefits beyond what is covered by Medicare Parts A and B:
– Is prescription drug coverage included? If so, will it increase the monthly plan premium or meet a certain deductible before coverage begins?
– Is the drug I take on the plan’s list of covered drugs?
– Are there restrictions on the plan, such as which pharmacies I can use, or do I need pre-approval before getting a prescription?
– What wellness programs or fitness options does the program offer?
– Does the plan cover eye exams, new glasses, hearing aids and/or dental care?
– What other benefits and services are included?
– How much extra will I pay for these benefits?
Then take a detailed look at how to get covered services from doctors, hospitals, and other healthcare providers through the MA plan:
– Are my current or favorite doctors, specialists and hospitals included in the plan?
– Do I need to choose a Primary Care Physician? If yes, do I need their referral to see a specialist?
– Do I have to pay more (or all) if I go to a doctor or institution that is not in my plan?
– If I need services while traveling in other areas, or live in other areas of the country at certain times of the year, will the insurance cover it?
– Are there reputable skilled nursing facilities and home health care in the plan’s network when I need them?
Whether you’re considering Medicare Advantage vs. Medicare, or one MA plan vs. another, make sure you understand what each plan includes and what to expect. Some people like to ask their family doctor, insurance agent or trusted friend for advice. But in the end, the choice is up to you.