Private insurers offer Medicare Advantage Plans as an alternative to Original Medicare. Here are some tips to help you shop.
Although you may have heard about Medicare Advantage Plans (or how they fit in the Medicare universe), do you know how to get one?
Medicare Advantage Plans can be described as an “all in one” option to Original Medicare. They replace Medicare Part A (hospital coverage), Medicare Part B (“medical insurance”), and sometimes Medicare Part D (“drug coverage). They are also known as Medicare Part B, Medicare Part C, or MA Plans. They’re offered only by private insurers approved by Medicare. Many plans provide additional benefits that are not covered by Original Medicare. These may include vision, hearing, and dental coverage. While you will likely need to stay with the network of doctors, your out-of-pocket expenses may be lower.
What should you do first?
Medicare’s Plan Finder tool is the best place to begin shopping for Medicare Advantage Plans or Part D or Medigap policies. After answering a few questions about your location and any financial help you might be receiving — from Medicaid, for instance — the tool will show you all available plans that meet your criteria.
You can use the following information to compare drug costs: Enter the name, dosage and frequency of each medication you take, as well as the pharmacy where prescriptions are filled. Your expected drug costs for each plan will be displayed on the final list. Filter by benefits, rating, ratings, insurance carrier, and drug coverage options. You can compare up to three plans side-by-side.
You can get help from the SHIP network, which is a state-run health insurance assistance program that provides live human support for those who are overwhelmed by online tools. Riaz Ali (CEO and founder of Saeidan, a health solutions company that offers plan comparisons and advice) says it’s the equivalent to a hotline or in person counseling. They won’t recommend a plan but can guide you through the process. Each state has its SHIP program. Find yours at shiptacenter.org.
What Medicare Advantage Plans Are Available?
There are five types Medicare Advantage Plans.
- HMO (Health Maintenance Organization) plans: You must see an HMO provider unless you are in an emergency. Most HMO plans require a referral to a specialist.
- Plans called Preferred Provider Organization (or PPO): These plans allow you to see both out-of-network and in-network providers. However, it is usually more costly to get out of network.
- Private fee-for service, or PFFS plans: These plans allow you to see any Medicare-approved provider, as long as they agree to the plan’s payment terms. A network of providers may be available to you. While you can visit doctors who don’t accept your plan’s payment terms but may still be able to pay more,
- SNPs, or special needs plans: These plans provide benefits for people who have certain diseases or need to receive health care such as a place in a nursing facility. These plans provide benefits for people with limited incomes.
- You can combine a high-deductible plan with a medical savings program, also known as MSA plans. This account can be used to pay for your health care costs.
What should you think about?
Rural residents might not have many options for Medicare Advantage, but urban dwellers may have several choices. These strategies will help you narrow the field.
- Find the star rating. Medicare collects data on Medicare Advantage Plans from member surveys, the plans themselves and health care providers, then assigns a star rating based on its findings. Anne Tumlinson (CEO of ATI Advisory), a health care research and consulting firm, says that the star rating is based on plan performance. You can choose from 1-5 stars. 5 stars are excellent.
- Take a look at the numbers. These two main cost factors are the plan’s premium, and the maximum out of pocket cost. This is the amount you will pay each year for covered healthcare. Ali states that this is something most people care about.
- Take into account your meds. You can enter your prescriptions into the Medicare Plan Finder or private comparison websites to determine coverage and cost.
- Cross-reference all your health care providers. You will want to have a plan that includes your regular network of medical providers and caregivers.
- Consider your personal preferences. A PPO plan is better than an HMO if you visit specialists often and don’t need to request a referral every time you go. An HMO may be cheaper if you are a low-income patient who sees only your primary care doctor.
- Visit the website of your plan. Go to the provider’s site and ensure you fully understand the plan’s benefits and limitations before you decide to sign up for a plan. Tumlinson states that plans now offer new and more diverse benefits like in-home palliative. These are great benefits and worth considering if you have a specific need. These new benefits can be quite limited so make sure to check the plan.
- Contact the carriers. Ali advises consumers to contact the carrier directly if they are interested in enrolling or changing their plans. Ali states that the best source of information is from the carrier. If you are interested in switching carriers, get in touch with them. You should do more research.
What time can you sign up for an account?
You can sign up for a Medicare Advantage plan (or switch between one and another) during these windows:
- During your initial enrollment period.
- Each year during open enrollment from Oct. 15 to Dec. 7.
- You can switch between MA Plans from Jan. 1 through March 31 during Medicare Advantage open enrollment. However, you cannot enroll in an MA Plan if you don’t have one.
Switching plans will result in you being automatically unenrolled from the old plan when your new one begins.
You can reach Medicare at 1-800-MEDICARE (1 800 633-4227) or visit Medicare.gov for more information.
