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How to Choose a Medicare Advantage Plan
By Jim Miller
Medicare
Advantage plans have become increasingly popular among retirees over
the past few years. In fact, around one-fourth of all Medicare recipients — nearly
13 million Americans — are currently enrolled in a Medicare
Advantage plan. Here are some tips and tools to help you choose the
best plan for you.
Medicare Advantage
Sometimes called Medicare Part C, Medicare Advantage plans are government approved
health plans sold by private insurance companies that you can choose in place
of original Medicare. The vast majority of Advantage plans are managed-care policies
such as HMOs or PPOs that require you to get your care within a network of providers.
If you join an Advantage plan, the plan will provide all of your Part A (hospital
insurance) and Part B (medical insurance) coverage — some plans even offer
extra benefits like vision, dental and hearing. And, most plans include Part
D prescription drug coverage too.
You also need to be aware that the monthly premiums for many Advantage plans
are cheaper than if you got original Medicare, plus a separate Part D drug plan
and a Medigap policy, but their deductibles and co-pays are usually higher. That
makes these plans better suited for healthier retirees.
How to Choose
To help you choose a plan, a good first step is to call your doctors and find
out which Advantage plans they accept, and which ones they recommend. Then go
to the Medicare Plan Finder tool at www.medicare.gov/find-a-plan and compare
those options. When comparing, here are some key points to consider:
Total costs: Look at the plan’s entire pricing package, not just the premiums
and deductibles. Compare the out-of-pocket maximums plus the copays and coinsurance
charged for doctor office visits, hospital stays, diagnostic tests, visits to
specialists, prescription drugs and other medical services. This is very important
because if you choose an Advantage plan, you’re not allowed to purchase
a Medigap supplement policy, which means you’ll be responsible for paying
these expenses out of your own pocket.
Drug coverage: Check the plan’s formulary — the list of prescription
drugs covered — to be sure all the medications you take are covered without
excessive co-pays or requirements that you try less expensive drugs first.
Extra benefits: Many Advantage plans include dental, vision and hearing benefits,
but they are often limited. Get the details on what exactly is covered.
Out-of-network coverage: Since most Advantage plans limit you to using in-network
doctors only, find out what’s covered if you have an emergency outside
your network area. This is especially important if you travel extensively or
live part of the year outside your network.
Locations: If you don’t use any particular doctors and you live in a rural
area, make sure the doctors in the plans you’re considering are located
near you. Also check to see if the hospitals, home health agencies and skilled
nursing facilities that the plan covers are nearby too.
Retiree benefits: If you have coverage from a former employer, be sure you speak
with the benefits manager, because signing up for Medicare Advantage may void
your retiree coverage.
Get Help
If you don’t have a computer to compare plans, or if you don’t feel
comfortable working through this information on you own, you can get help by
calling Medicare at 800-633-4227. They can do the comparing for you over the
phone, and enroll you in a plan when you’re ready.
Another good resource is your State Health Insurance Assistance Program, which
provides free Medicare counseling. Visit shiptalk.org, or call 800-677-1116 to
locate a counselor in your area. And, check out the HealthMetrix Research “Cost
Share Report” at medicarenewswatch.com. This service chooses the best Advantage
plans based on health status.
This page and its contents ©2012
Metropolitan News Company, Inc.
