The Best Medicare Advantage Plan – 5 Tips To Help You Choose

Medicare Supplements and Medicare AdvantageThere are, most likely,  several Medicare Advantage Plan choices in your area.

The benefits and costs vary from plan to plan.

So how do you compare Medicare Advantage Plans to find the best plan?……the following tips are a good start.


Medicare vs. Medicare Advantage

Most people qualify for Medicare when they turn 65. It covers most but not all of your health care costs.

Original Medicare has two parts. Part A covers in-hospital costs and Part B covers outpatient medical expenses.

You will pay a deductible out-of-pocket when you enter the hospital, and you will pay about 20% out-of-pocket for all outpatient costs like doctor visits, lab work, tests, ambulance service, and outpatient surgeries.

And, unless you have Medicare Prescription Drug Coverage, you will pay all costs for most of your prescription drugs.

Generally, you will not have to pay a monthly premium for Part A, and you will pay a monthly premium ($104.90 in 2014) for Part B.

So, many individuals turning 65 or older enroll in a Medicare Advantage Plan (also known as Medicare Part C)  or a Medicare Supplement Plan to help pay for those out-of-pocket health care costs.

Here are some tips that will help you choose the right one:

1) Check the Doctor Network

Most Medicare Advantage Plans require you to use healthcare providers in their network. If you have primary care doctors or specialists you have been using, and want to keep using, make sure they will continue to be in the network of the Medicare Advantage plan where you are enrolled.

The networks, which are the lists of approved doctors and hospitals by the Medicare Advantage plan, change frequently. If you go outside the network of your particular plan, you may be required to pay a much larger share of the cost, and in some, cases you may have to pay the full cost without any reimbursement from the insurer.

2) Re-Evaluate your plan if you have developed a serious illness or chronic condition.

It may be better to leave your Medicare Advantage plan, return to Original Medicare and perhaps enroll in a Medicare Supplement (Medigap) policy if your health status changes considerably.

Under original Medicare and a supplement, you have coverage for any doctor or hospital participating in the Medicare program. This means you can see any primary care doctor, any specialist, and receive treatment at any medical center specializing in your ailment or condition.

3) Examine the Formulary

The Formulary is the list of drugs that a Medicare Advantage Plan covers. Most Medicare Advantage Plans include Prescription Drug Coverage ( Medicare Part D).

Check your drugs for coverage under the plan. The list of approved drugs by is constantly changing. Plans add and remove drugs, and change the co-payments and deductibles for these medications.

The government’s official Medicare website, medicare.gov,  has a very good plan finder tool to check the formulary of every plan offered in your area. (It can be a little confusing at first. Give our office a call, and we can guide you through the steps. 415-999-5071.)

4) Check the Total Cost of a Plan

A Medicare Advantage cost is not just the premium. You need to know the copays, deductibles and coinsurance that elevate your total annual cost.

When seniors start to Compare Medicare Advantage Plans, they are attracted by a plan that has a very small or even a zero monthly premium. You need to check further. The plan finder tool at Medicare.gov will also show you the total estimated annual health and drug costs, to see what a plan is likely to cost you.

Again,  call us (415-999-5071) if you would like some help navigating Medicare plan finder tool.

5) Look at the Medicare Advantage Star Ratings

The federal government gives plans ratings between one and five stars.

The 5-star plans are called “excellent” by the federal government, and the four-star plans are designated “above average.”

About 40% of all plans nationwide have a 4-star or better rating. The ratings are based on several performance levels including level of preventative screenings, customer service, managing chronic conditions, member complaints, and member experience.

In conclusion,

In choosing the right plan, you will need to compare Medicare Advantage Plans with the 5 tips we listed above (and then some).

This takes a bit of homework, and Medicare.gov is a good place to start.

Call us to get the latest information about networks, formularies and star ratings of the plans in your area. 415-999-5071 or drop us a line.


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