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How To Choose A Medicare Advantage Plan

When shopping around for a Medicare Advantage plan this year, you may be wondering what the best plan is for you. It all depends on your personal situation, medical needs, how much you can afford, and other factors.

This article will explore how to determine which Medicare Advantage plan is best for your situation. 


What is a Medicare Advantage plan?

Medicare Advantage is a type of health plan offered by a private insurance company that contracts with Medicare to provide you with all benefits for Medicare Part A and Medicare Part B Coverage. 

Medicare Advantage plans include health maintenance organizations, preferred provider organizations, private fee-for-service plans, and Special Needs Plans.

Medicare Advantage plans are offered through Private Insurance Companies which Medicare approves. These plans are often bundled together with two to three other parts of Medicare:

 

  • Part A Benefits: Hospital Insurance, Hospice Care, Skilled Nursing Facilities

  • Part B Benefits: Doctor and Outpatient Services, Annual Wellness Checks, Urgent Care

  • Part D Benefits: Prescription Drug Plan

There are some Medicare Advantage plans that have some coverage for services not included in Original Medicare, such as Dental Care, Hearing Care, and Vision Care. 

When choosing Medicare coverage from a Private Insurance Company, you’ll have several plans to choose from in your geographic area. 

Note: Premiums, Co-Payments for Medical and Drug Coverage, Covered Drugs, and Provider Networks can vary from plan to plan.

Consider costs and coverage for your typical medical needs and prescription drugs when choosing a plan. Another important factor in choosing the right plan is checking to see if your provider(s) and facilities are included in the plan’s network. 

 

Who can enroll in a Medicare Advantage plan?

You can join one of these Medicare Advantage Plans:

  • Health Maintenance Organization (HMO)

  • Preferred Provider Organization (PPO)

  • Private Fee-for-Service (PFFS)

  • Medical Savings Account (MSA) Plan

You will only be able to apply if:

  • You live in the service area of the plan you want to join. Each plan will give you further information about its service area.

  • You have Medicare Part A and Medicare Part B

  • You’re a U.S. citizen or lawfully present in the U.S.

 

What are the different types of Medicare Advantage Plans?

When selecting your Medicare Advantage plan, it’s important to know the differences between each type of plan:

1. Health Maintenance Organization (HMO plans)

HMO plans are primarily focused on in-network healthcare services and will require a referral.

Facts on HMO plans:

    • You will need to select a Primary Care Doctor.

    • You will need a referral from your Primary Care Doctor to see a Specialist.

    • If you get medical care or services from an out-of-network provider, you will have to pay the full cost.

2. Preferred Provider Organization (PPO) plans 

PPO plans to charge different rates depending on whether the services are in-network or out-of-network. 

Facts on PPO plans:

    • This plan gives you more flexibility when choosing Primary Care Doctors, Specialist Providers, and Hospitals.

    • You don’t need a Primary Care Doctor.

    • You can save money by selecting “Preferred Doctors”.

3. Private Fee-for-Service (PFFS) plan

PFFS plans allow you to receive care from any Medicare-approved provider who accepts the approved fee from your plan. 

Facts on PFFS plans:

    • This plan determines how it will pay each Doctor, Other Health Care Providers, or Facilities.
    • You don’t need to select a Primary Care Doctor.
    • If you have an emergency, doctors, providers, and hospitals have to treat you.

4. Special Needs Plans (SNPs) plans 

SNP plans offer additional help for medical costs associated with specific chronic health conditions. These plans may also have an over-the-counter benefit.

Facts on SNPs plans:

    • You must meet certain requirements in order to enroll in a Special Needs Plan: Have a Chronic Condition, Institutional SNP, or Dual Eligible SNP (D-SNP). Visit medicare.gov for further information on how SNPs plans work. 
    • If you have Medicaid and Medicare most costs of joining an SNP plan will be covered for you. Visit your local Medicaid office for further information.
    • SNPs plans cover the same services as a Medicare Advantage plan.

 

5. Medicare Savings Account (MSA) plans

MSA plans to combine a plan with a higher deductible with a medical savings account. 

Facts on MSA plans:

    • High-Deductible health coverage.
    • Medicare MSA plans do not cover Medicare Part D prescription drug coverage.
    • You can choose your healthcare providers and services. 

 

How to enroll in a Medicare Advantage plan

The open enrollment period starts on October 15 and lasts till December 7th, this period provides you the opportunity to review your plan annually and change your current Medicare coverage. 

During Open Enrollment Period, the below list shows you what changes can be made:

  • Join a Medicare Part C plan
  • Discontinue your Medicare Advantage plan and return to Original Medicare (Part A and Part B)
  • Change from one Medicare Advantage plan to another
  • Add or change your Prescription Drug Coverage (Part D), if you are enrolled in Original Medicare

If you are enrolled in a Medicare Advantage plan, you will have a one-time opportunity to make changes to your Medicare coverage. This includes switching to a different Medicare Advantage plan or returning to Original Medicare with the option of enrolling in a Prescription Drug Coverage plan.

Tips to consider when selecting a Medicare Advantage plan:

  • Cost: How much will I pay for premiums, deductibles, coinsurance, and copayments?
  • Doctors and Hospitals: Do the healthcare providers I use accept the plan? Are my doctors in-network? What network does this plan have?
  • Benefits: Does this plan have all the benefits I need? Dental, Vision, and Hearing Aids. What benefits are most important to me?
  • Health History: How often do you need medical care? Are you fairly healthy or have a chronic condition that needs frequent doctor visits and treatment? 

 

Common Questions About Medicare Advantage plans


How does Medicare Advantage cover my prescription drugs?

To find out which prescription drugs are covered, visit the https://www.medicare.gov/ website”, click “Health & Drug Plans”, followed by “Find Health & Drug Plans”.  You will then be prompted to type in your zip code in the search. 

From there, you’ll get a list of the plans in your area which will show the monthly premium and yearly drug and premium cost specifically for your medication.

How much is the deductible and coinsurance on Medicare Advantage plans?

These amounts vary depending on the location, the service area, the plan selected, and the Private Insurance Company provider. 

Each plan usually has a fixed deductible and/or coinsurance amount. Your cost share will typically be higher for visiting non-network providers.

How much are the monthly premiums for Medicare Advantage?

Every plan is different, however many plans offer a low or $0 monthly plan premium based on the plan you choose.

Note: You must continue to pay for the Part B monthly premium that you have.  

 

How much is the deductible and coinsurance on Medicare Advantage plans?

These amounts vary depending on the location, the service area, the plan selected, and the Private Insurance Company provider. Each plan usually has a fixed deductible and/or coinsurance amount. 

Your cost share will typically be higher for visiting non-network providers.


Do my Medicare Advantage plan cover doctors, facilities, and other providers I want?

Medicare Advantage plans have provider networks, so you’ll need to find out whether the doctors, hospitals, and outpatient clinics you want to use are covered. Refer to the Provider & Services page on https://www.medicare.gov/, and find a care provider. 

Another important factor is finding out how your Medicare Advantage plan will treat your use of an out-of-network provider:

    • Health Maintenance Organizations (HMOs) pay nothing for out-of-network providers except for emergencies. 

    • Preferred Provider Organizations (PPOs) cover out-of-network providers but charge higher copayments and have a higher out-of-pocket spending limit for out-of-network services. 

Final Reminders When Enrolling in a Medicare Advantage Plan

To enroll in a Medicare Advantage plan:

  • You must have Medicare Part B Coverage in order to enroll in a Medicare Advantage plan and keep paying your Medicare Part B premium to stay in your plan.

  • Medicare Advantage out-of-pocket varies by plan. Once you pay the plan’s limit, the Medicare Advantage plan pays 100% of your covered medical services for the rest of the calendar year.

  • You can’t buy and won’t need a Medigap policy.

  • You can join a Medicare Advantage plan even if you have pre-existing conditions.

  • You can only be signed up for one Medicare Advantage plan.

To find a Medicare plan and to compare Health and Drug Plans that meet your needs, visit medicare.gov/plan-compare to shop and compare plans that meet your need, or call 1-800-MEDICARE for any specific questions about billing, claims, medical records, and more. Teletypewriter (TTY) users can call 1-877-486-2048.

Shelia Benson

Shelia Benson was born and raised in Las Vegas, Nevada. She comes from a family of insurance professionals and has 12 years of experience in the insurance industry as a licensed agent and is also certified in Medicare. It's her passion to be of service to consumers turning 65 or coming onto Medicare for the first time. During her free time, she loves to spend time with family and her dog, working out, hiking, trying out new restaurants, and going to concerts. Shelia's goal is to educate the Medicare-eligible about how Medicare works.

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