Summary: There are several different types of Medicare Advantage plans. You can look at them from several angles to help you decide which plan may be the best for you. For example:
- Does the plan cover my prescriptions?
- How much will the plan cost me? Consider the premium, deductible, copayments/coinsurance, and the out-of-pocket maximum.
- Does the plan offer the extra benefits I want or need?
- Is my favorite doctor in the plan’s network?
Deciding if your Medicare Advantage plan is right for you
Medicare Advantage, also known as Medicare Part C, is a popular alternative way to get your Original Medicare (Part A and Part B) health-care benefits. Medicare Advantage plans must cover everything Original Medicare covers, except hospice care, which is still covered by Part A.
If you’re currently enrolled in a Medicare Advantage plan, it’s a good idea to review your plan options from time to time in order to make sure your plan is the best one for your particular needs. Here are a few things to consider before making a switch.
Of course, you’ll want to make sure you have the best Medicare Advantage plan for your situation. Here are different factors to think about when you compare Medicare Advantage plans.
Medicare Advantage plans – consider your costs
Here are some questions to ask as you consider the cost of your Medicare Advantage plan:
- Are you paying more out-of-pocket than you expected? For example, if you are paying a low monthly premium but have a high annual deductible, is the deductible amount more than what you save in your premium?
- Do you have trouble meeting your copayment or coinsurance amounts?
- Are you satisfied with the plan’s coverage of your medications?
These questions can help you decide whether your current plan is affordable for you. If not, it may be time to look at other Medicare Advantage plans to find a better fit for your budget.
As you begin to compare costs of Medicare Advantage plans, these factors might help you narrow down your options.
- If you spend more money on your prescriptions, consider a plan that offers better prescription drug coverage. An eHealth study found that most Medicare beneficiaries they surveyed could save money on medications by switching to a different plan.
- If most of your expenses involve office visits to specialists, look for a plan with a lower copayments or coinsurance.
- If you spend the most money on your monthly premiums, look for Medicare Advantage plans with lower premiums (keep in mind lower premiums could mean a higher deductible).
- Every Medicare Advantage plan has an annual out-of-pocket maximum amount. Does another similar plan have a lower maximum?
- Are you on a tight budget? If your preferred providers are is in your plan’s network, switching to an HMO with low copayments and low monthly premiums may save you money.
- Do you have frequent doctor visits? A plan with a lower out-of-pocket maximum may be more cost-effective for you over the long term.
- Maybe you need routine dental work, wear prescription eyewear, or have hearing aids. A Medicare Advantage plan with those extra benefits could save you more out of pocket.
Medicare Advantage plans – is your preferred doctor part of the plan network?
Has your plan made any changes that could affect your access to care? Here are some questions to ask yourself:
- Did your doctor stop accepting your plan?
- Did your specialist retire?
- Does your plan offer enough choices for in-network providers in your area?
If your favorite doctor or clinic isn’t in your current plan’s provider network, you may want to compare Medicare Advantage plans to ensure those providers are covered.
Medicare Advantage plans – does your plan cover the extra benefits you need?
Medicare Advantage plans might cover more than your Medicare Part A and Part B benefits. Many plans offer more benefits. Here’s just a small sampling of possible extra benefits these plans are allowed to offer.
- Prescription drug coverage
- Routine dental coverage
- Fitness membership
- In-home safety inspections
- Enhanced disease management
You’d have to qualify for certain benefits, such as enhanced disease management.
Is it time to change Medicare Advantage plans?
What if you decide your Medicare Advantage plan no longer meets your health or budget needs? You might be able to change plans. There are certain enrollment periods when you can change Medicare Advantage plans.
If your Medicare Advantage plan still meets your needs
If you are happy with your current Medicare Advantage plan, you do not have to worry about doing anything. Unless your plan leaves your service area or stops contracting with Medicare, you can stay with the plan you know and trust.
But it’s always a good idea to look at the plan’s Annual Notice of Change, which it sends you every year in the fall. That’s where you’ll see any coverage or cost changes coming up.