How to Compare Medicare Advantage Plans

Key Takeaways:

1. Assess Your Needs & Budget: Prioritize plans that align with your healthcare requirements and financial situation to minimize out-of-pocket costs.
2. Compare Provider Networks: To maintain continuity of care, ensure the plan includes your preferred doctors, hospitals, and specialists.
3. Evaluate Additional Benefits: Consider extras like dental, vision, and wellness perks to maximize value and support overall health.

Choosing the right Medicare Advantage plan has far-reaching consequences on both your healthcare and budget. It impacts your healthcare costs, access to specific health services, and the ability to stay within your preferred network of doctors, hospitals, and other healthcare providers. Overall, making an informed decision about your Medicare Advantage plan can improve health outcomes and financial stability. Many Medicare beneficiaries face this issue because of the sheer number of Medicare Advantage plans and providers, each offering varying coverage options and costs. That means finding one that suits you just right is not always easy. This article demystifies the complex world of Medicare Advantage plans and gives you the knowledge and insights necessary to compare plans and make confident decisions. Let’s find out how to compare Medicare Advantage plans in detail.

What are Medicare Advantage Plans?

Medicare Advantage (Part C) plans are private alternatives to Original Medicare, offering the same core benefits as Parts A and B, often with added perks like drug, dental, and vision coverage. Created in 1997, these plans give beneficiaries more choice and aim to improve care through managed networks.

Medicare Advantage Eligibility

Here are the key points to remember about Medicare Advantage eligibility:

1. Original Medicare: You must be eligible for Original Medicare to enroll in a Medicare Advantage plan.
2. Service Area: You must live within the geographic area covered by the plan you want to join.
3. ESRD Exclusion: Individuals with End-Stage Renal Disease (ESRD) are not eligible for Medicare Advantage.

Medicare Advantage Enrollment

There are four enrollment periods when you can sign up for Medicare Advantage:

• Initial Enrollment Period (IEP): It begins three months before your 65th birthday, includes your birth month, and extends three months thereafter.
• Annual Enrollment Period (AEP): From October 15 to December 7 of each year, you can switch between Original Medicare and Medicare Advantage or change Medicare Advantage plans.
• Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 of each year, you can switch Medicare Advantage plans or return to Original Medicare.
• Special Enrollment Periods (SEPs): SEPs are triggered by qualifying life events such as relocating to another state or losing employer coverage.

How to Shop Medicare Advantage Plans

When comparing Medicare Advantage plans, it’s essential to look beyond just the monthly premium. Each plan combines different cost structures, provider access, and added benefits that can significantly impact your healthcare experience. As you evaluate your options, focus on these four key areas:

1. Costs: Monthly premiums, deductibles, copayments, and out-of-pocket costs can vary widely based on the state, provider, and additional benefits opted for. Make sure also to check the maximum out-of-pocket expense for each plan.
2. Coverage: Medicare Advantage plans must provide all the benefits Original Medicare offers. Compare plans for the right mix of additional benefits, such as vision, dental, and hearing services, prescription drug coverage, and specialized care.
3. Provider Networks: Each Medicare Advantage plan works with a network of contracted hospitals, healthcare providers, pharmacies, and medical equipment suppliers. ‘In-network’ services cost significantly less than those received out of network.
4. Extra Benefits: In addition to prescription drug coverage and dental and vision services, extra benefits under Medicare Advantage plans can cover transportation for medical appointments, fitness activities, alternative therapies, and home modifications for accessibility.

Here’s a breakdown of the costs, coverage, and provider network differences between three sample Medicare Advantage plans.

Name of Medicare Advantage Plan	Provider	Cost	Coverage	Provider Network	Max Out-of-Pocket
AARP Medicare Advantage from UHC CO-0001 (HMO-POS)	United Healthcare	$51 monthly premium $0 annual deductible	Annual physical, PCP and specialist visits, preventive services, therapy, Rx, dental, hearing, and vision	Limited to participating provider network	$2,900
Humana Gold Plus Giveback (HMO)	Humana	$0 monthly premium $100 medical deductible	Primary care, Rx, hospital and X-ray costs, dental, vision, hearing, and preventive benefits	28,000 participating providers	$5,400
Cigna True Choice Medicare (PPO)	Cigna	$0 monthly premium $400 annual deductible	Rx, dental, vision, hearing, OTC drugs, and fitness programs	Limited to participating provider network	$5,200

How to Choose the Right Medicare Plan for Your Needs

Besides budget, choosing the best Medicare Advantage plan calls for carefully evaluating your healthcare needs and lifestyle. Here’s what’s most important:

• Chronic Conditions: Look for a Special Needs Plan (SNP) If you suffer from a disabling or chronic condition like diabetes or heart disease. SNPs are a category of Medicare Advantage plans that offer better coverage for specific situations.
• Frequent Travel: For those who travel frequently or split their time between different states, a preferred provider organization (PPO) plan offers better flexibility. These plans may cover some out-of-network providers and provide emergency health insurance abroad.
• Prescription Drugs: Ensure the required drugs are included in the plan formulary or list of covered drugs. Compare deductibles, copays, and out-of-pocket costs for different plans. Look for plans that offer mail-order pharmacy discounts.

How to Compare Medicare Advantage Plans

Here’s what you must do:

1. Prepare Your Paperwork: This includes your Medicare card (if you’re already enrolled), Social Security card, proof of citizenship or legal residency, and a list of current medications and healthcare providers.
2. Use Trusted Comparison Tools: Licensed insurance agencies like CoverRight offer personalized guidance on comparing plans and selecting one that best suits your current healthcare needs and lifestyle.
3. Understand Plan Documents: Like the ‘summary of benefits’, a concise document outlines covered services, cost-sharing details, and coverage limitations for each plan.
4. Review Ratings and Feedback: Check the Medicare website and independent third-party agencies for star ratings of different plans. When evaluating plans, compare network access and customer service quality.

Make the Right Medicare Advantage Choice with CoverRight

Picking the right Medicare Advantage plan is easy with CoverRight at your side. Our licensed advisors examine your medical status, lifestyle, and financial situation holistically before suggesting plans that optimize your Medicare coverage while minimizing costs. Reach out to CoverRight today to make the most of Medicare.

What Types of Medicare Advantage Plans Are There?

Now that we understand the basics of Medicare Advantage plans, and their additional benefits, let’s delve into the different types of Medicare Advantage plans available. Each type caters to specific healthcare needs and preferences, offering varying coverage and costs. Understanding these types can significantly aid in making an informed decision about your healthcare coverage. These are the types of Medicare Advantage plans that you can choose from:

Health Maintenance Organization (HMO) Plans

HMO plans require you to seek care from in-network providers, except in emergencies. Most HMOs mandate a referral from your primary care physician to see a specialist, ensuring coordinated and centralized care within the network.

Preferred Provider Organization (PPO) Plans

PPO plans offer a bit more flexibility. You can choose healthcare providers both within and outside the plan’s network. While seeing out-of-network providers is an option, it often comes at a higher cost. PPO networks typically operate within local areas, though some plans extend coverage to broader regions.

Special Needs Plans (SNPs)

SNPs are tailored to meet the specific needs of certain groups, such as individuals eligible for both Medicare and Medicaid, those requiring institutional-level care, or individuals with specific chronic or disabling conditions like diabetes, chronic heart failure, or dementia. SNPs focus on enhancing the management of care for these unique beneficiary groups.

Private Fee-for-Service (PFFS) Plans

PFFS plans provide the freedom to see any Medicare-approved healthcare provider, provided they accept the plan’s payment terms and agree to treat you. Some PFFS plans also feature a network of providers. You might incur higher costs if you visit doctors who don’t agree to the plan’s payment terms.

Medical Savings Account (MSA) Plans

MSA plans to combine a high-deductible insurance policy with a medical savings account. The savings account can be utilized for various healthcare expenses, offering a flexible approach to managing healthcare costs while providing coverage for essential services.

Frequently Asked Questions

Q. How do I find Medicare Advantage plans in my area?

Go to the official Medicare website to use the Plan Finder tool to find and compare Medicare Advantage plans by location. You can also seek guidance from licensed insurance agents specializing in Medicare Advantage coverage.

Can I change my Medicare Advantage plan if my healthcare needs change?

You can change your Medicare Advantage plan during the Annual or Special Enrollment Period, which covers specific life events. These periods allow you to reevaluate your healthcare needs and adjust your coverage.

Can I keep my current doctors with a Medicare Advantage plan?

It depends on your Medicare Advantage plan and whether your current doctors are in-network providers under that particular plan. Some Medicare Advantage plans have broad networks that include a wide range of providers, while others have more limited networks. Check your plan details to ensure your preferred doctor is in this network.

How do I enroll in a Medicare Advantage plan?

You can enroll in a Medicare Advantage plan during the Annual Enrollment Period or the Special Enrollment Periods, which are set off by specific live events like retirement, loss of a spouse, or relocation to another area of the country. Contact Medicare or consult a licensed insurance agent for more detailed information on enrollment and deadlines.