How to Choose a Medicare Advantage Plan
I will be 65 and eligible for Medicare in a few months. I am interested in getting a Medicare Advantage plan to cover my health care and medications. What tips can you provide to help me pick a plan?
Medicare Advantage plans have become very popular among retirees over the past 15 years. Nearly half of all new Medicare enrollees are signing up for Advantage plans, accounting for about 42% of the entire Medicare market. Here are some tips and tools to help you pick a plan that fits your needs.
Medicare Advantage plans (also known as Medicare Part C) are government approved health plans sold by private insurance companies that you can choose in place of original Medicare. The majority of Advantage plans are managed-care policies such as HMOs or PPOs that require you to get your care within a network of doctors.
If you join an Advantage plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage like original Medicare does. However, many plans also offer extra benefits such as dental, hearing and vision coverage, gym/fitness memberships, and prescription drug coverage.
Medicare Advantage plans are also more affordable than if you were to purchase original Medicare, plus a separate Part D drug plan and a Medigap policy. Many Advantage plans have $0 or low monthly premiums and do not always have a deductible, but they typically have a high out-of-pocket maximum. In 2021, Advantage plan participants on average were responsible for an out-of-pocket maximum of around $5,100 for in-network care, and about $9,200 for out-of-network care.
To help you pick a plan, a good first step is to call the office managers of the doctors you use and find out which Advantage plans they accept and recommend. Then, go to the Medicare Plan Finder tool at Medicare.gov/plan-compare to compare Advantage plans in your area. This tool provides a five-star rating system that evaluates each plan based on past customer satisfaction and quality of care the plan delivers. When comparing, here are some key points to consider:
Total costs: Look at the plan's entire pricing package, not just the premiums and deductibles. Compare the maximum out-of-pocket costs plus the copays and coinsurance charged for doctor office visits, hospital stays, visits to specialists, prescription drugs and other medical services. This is important because if you choose an Advantage plan, you are not allowed to purchase a Medigap policy, which means you will be responsible for paying these expenses out of your own pocket.
Drug coverage: Check the plan's formulary – the list of prescription drugs covered – to be sure all the medications you take are covered without excessive co-pays or requirements.
Dental, vision and hearing: Many Advantage plans come with dental, vision and hearing benefits, but are usually limited. Get the details on what exactly is covered.
Coverage away from home: Most Advantage plans limit you to using in-network doctors only within a service area or geographic region, so find out what is covered if you need medical care when you are away from home.
Out-of-network coverage: Check to see what is covered if you want to see a specialist in a hospital that is not in a plan's network. You can get a list of doctors and hospitals that take part in a plan on the plan's website.
If you need help choosing a plan, contact your State Health Insurance Assistance Program at ShipHelp.org or call 877-839-2675. Also see the HealthMetrix Research 2022 Cost Comparisons Report at MedicareNewsWatch.com that lists the best Advantage plans based on health status.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Medicare Advantage plans have become very popular among retirees over the past 15 years. Nearly half of all new Medicare enrollees are signing up for Advantage plans, accounting for about 42% of the entire Medicare market. Here are some tips and tools to help you pick a plan that fits your needs.
Medicare Advantage plans (also known as Medicare Part C) are government approved health plans sold by private insurance companies that you can choose in place of original Medicare. The majority of Advantage plans are managed-care policies such as HMOs or PPOs that require you to get your care within a network of doctors.
If you join an Advantage plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage like original Medicare does. However, many plans also offer extra benefits such as dental, hearing and vision coverage, gym/fitness memberships, and prescription drug coverage.
Medicare Advantage plans are also more affordable than if you were to purchase original Medicare, plus a separate Part D drug plan and a Medigap policy. Many Advantage plans have $0 or low monthly premiums and do not always have a deductible, but they typically have a high out-of-pocket maximum. In 2021, Advantage plan participants on average were responsible for an out-of-pocket maximum of around $5,100 for in-network care, and about $9,200 for out-of-network care.
How to Choose
To help you pick a plan, a good first step is to call the office managers of the doctors you use and find out which Advantage plans they accept and recommend. Then, go to the Medicare Plan Finder tool at Medicare.gov/plan-compare to compare Advantage plans in your area. This tool provides a five-star rating system that evaluates each plan based on past customer satisfaction and quality of care the plan delivers. When comparing, here are some key points to consider:
Total costs: Look at the plan's entire pricing package, not just the premiums and deductibles. Compare the maximum out-of-pocket costs plus the copays and coinsurance charged for doctor office visits, hospital stays, visits to specialists, prescription drugs and other medical services. This is important because if you choose an Advantage plan, you are not allowed to purchase a Medigap policy, which means you will be responsible for paying these expenses out of your own pocket.
Drug coverage: Check the plan's formulary – the list of prescription drugs covered – to be sure all the medications you take are covered without excessive co-pays or requirements.
Dental, vision and hearing: Many Advantage plans come with dental, vision and hearing benefits, but are usually limited. Get the details on what exactly is covered.
Coverage away from home: Most Advantage plans limit you to using in-network doctors only within a service area or geographic region, so find out what is covered if you need medical care when you are away from home.
Out-of-network coverage: Check to see what is covered if you want to see a specialist in a hospital that is not in a plan's network. You can get a list of doctors and hospitals that take part in a plan on the plan's website.
Need Help?
If you need help choosing a plan, contact your State Health Insurance Assistance Program at ShipHelp.org or call 877-839-2675. Also see the HealthMetrix Research 2022 Cost Comparisons Report at MedicareNewsWatch.com that lists the best Advantage plans based on health status.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Published April 8, 2022
