Top Reasons to Choose a Medicare Advantage Plan

Top Reasons to Choose a Medicare Advantage Plan

Medicare beneficiaries have options when it comes to choosing healthcare coverage. Whether you are just approaching Medicare eligibility, or taking advantage of Medicare’s Annual Enrollment Period from October 15 through December 7 to make changes to your coverage, you may be considering the benefits of enrolling in a Medicare Advantage (MA) plan. There are a variety of factors to consider when it comes to choosing the Medicare insurance that is right for you, and you deserve all the information you need to make this very personal decision. 

Medicare recipients have two options when getting their benefits:

  1. Original Medicare
  2. Medicare Advantage

Original Medicare and Medicare Advantage – the Basics

Original Medicare is the program run by the federal government that administers your Part A (hospital insurance) and Part B (medical insurance) benefits. People who qualify for Medicare based on working at least 40 quarters of employment and paying into Social Security will automatically be enrolled in premium-free Part A. When you become eligible for Medicare due to age or disability, you may be enrolled in Part B, but you will need to pay a premium and yearly deductible for Part B benefits.

Medicare Advantage (MA) plans offer an alternative to Original Medicare. Provided by private insurance companies contracted by Medicare, Medicare Advantage, or Part C, coverage must include your Part A and Part B benefits, but many MA plans offer additional coverage.

How to Get the Coverage You Need

Many Medicare recipients are satisfied with Part A and Part B until they experience a medical crisis that incurs unexpected out-of-pocket expenses or prescription medications. With Original Medicare, you generally pay 20% of the cost of medical services as long as you visit a physician that accepts assignment.

Some individuals purchase supplemental insurance, or Medigap coverage, to help cover some of the costs that Medicare does not, including copayments, coinsurance, and deductibles. Unfortunately, Part A, Part B, and Medigap coverage does not include any prescription drug insurance. Stand-alone Prescription Drug Plans (PDPs) are sold by private insurance companies to help cover the cost of prescribed medications if you have Original Medicare.

While you may be comfortable with your Medicare, Medigap, and PDP coverage, you may be wondering if there’s a simpler and more affordable way to approach your insurance coverage.

Why Choose a Medicare Advantage Plan?

Medicare Advantage plans are offered by private insurance carriers and are mandated by the federal government to include at least the same benefits as Part A and Part B, but most MA plans include much more.

Many MA plans include additional benefits such as:

  • Vision care (exams, eyeglasses)
  • Hearing exams
  • Routine dental care
  • Fitness club membership
  • Prescription drug coverage

Plan premiums vary, but you would still be responsible for paying your Part B premium, an annual deductible, copayments, and possible coinsurance for certain supplies, but laws require MA plans to cap yearly out-of-pocket expenses. Maximum out-of-pocket expenditures can vary between Medicare Advantage plans. 

Types of Medicare Advantage Plans

There are different types of Medicare Advantage plans for you to choose from, including:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans
  • HMO Point of Service (HMOPOS) Plans
  • Medical Savings Account (MSA) Plans

The most common MA plans chosen by Medicare beneficiaries fall within the HMO and PPO categories:

HMO Plans

HMO plans will allow you to visit doctors, hospitals, pharmacies, and suppliers within the plan’s network, except for emergency or out-of-area urgent care or dialysis. You generally have a primary care physician who manages your care. In order to visit a specialist, you will need to get a referral from your primary care physician. If you go outside the network, you will likely be required to pay the full price of the treatment or services.

PPO Plans

PPO plans allow enrollees to visit providers within the plan’s network for a lower cost, but you have the flexibility to go outside your plan’s network and for a higher price.  PPOs do not require you to get a referral from a primary care physician to see a specialist.

If you consider getting your Medicare benefits through a Medicare Advantage Plan, you can choose the type of plan that best meets your financial and healthcare coverage needs.

The Benefits of Medicare Advantage Plans With Prescription Drug Coverage

Many Medicare recipients find that enrolling in a Medicare Advantage plan with prescription drug coverage when they are first eligible can save them money. If you choose not to enroll in any prescription drug coverage when you are first eligible, you will likely incur late enrollment penalty later. Even if you do not require any medications when you first become eligible, you may want to consider your future needs. Life is unpredictable, and the cost of medications necessary to improve or maintain your health can cause financial stress if you don’t have any insurance to help cover those costs.

The costs of prescription drugs can vary between Medicare Advantage plans with prescription drug coverage (MA-PDs). If you are already taking medications, you can check individual plan formularies, or lists of covered drugs, to make sure your specific medications and dosages will be covered. Each plan has its own formulary, with different tiers of pricing based on generic, brand-name, and mail order drugs. 

Comparing Medicare Advantage Plans

Medicare Advantage plans vary in costs and benefits, so comparing them before enrolling is extremely important. Online plan search and comparison tools make it easier than ever to find a Medicare Advantage Plan that will meet your needs and preferences. You can customize your search for Medicare Advantage plans available in your area based on a personal assessment. Once you narrow down your choices, you can view plans side-by-side to inspect the details of each plan, including the costs of specific prescription drugs. You may want to consider consulting with a knowledgeable licensed sales agent who can help you navigate the process of enrolling in a Medicare Advantage plan.

Making Changes During Medicare’s Annual Enrollment Period

Medicare’s Annual Enrollment Period (AEP) is usually the only time during the year that allows Medicare beneficiaries to make changes to their insurance coverage. Unless you are eligible for a Special Enrollment Period (SEP), the AEP between October 15 and December 7 gives Medicare recipients the opportunity to:

  • Drop Original Medicare and enroll in a Medicare Advantage Plan, with or without prescription drug coverage
  • Change from one Medicare Advantage plan to another
  • Drop their Medicare Advantage plan and revert to Original Medicare

Take the opportunity to review your healthcare coverage and make sure you are comfortable with your medical expenses and choices. Explore your options and determine if a Medicare Advantage plan may be right for you.

Related Information:

The Top Ten Benefits of Using a Medicare Broker to Help You Pick a Plan

Easily Compare Medicare Plans With Our Simple Tool

Questions to Ask Before Enrolling in Medicare