how do i know if a medicare advantage plan is right for me

by Geoffrey Block Published 1 year ago Updated 1 year ago

An annual review of your Medicare coverage can help you determine if your plan combination is right for your needs. For example, if you’re spending a considerable amount of money on prescription drugs, a Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage may be something to consider.

To compare Medicare plans, use the Medicare Plan Finder at www.medicare.gov/find-a-plan, on the official U.S. government site for people with Medicare, which allows you to compare plans by cost, by quality and by other features that may be of importance to you.

Full Answer

How do I decide what coverage I Want for Medicare?

Use these steps to help you decide what coverage you want: 1 Decide if you want Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). 2 Decide if you want prescription drug coverage (Part D). 3 Decide if you want supplemental coverage.

What are Medicare Advantage plans and how do they work?

Medicare Advantage Plans provide all of your Part A and Part B benefits, with a few exclusions, for example, certain aspects of clinical trials which are covered by Original Medicare even though you’re still in the plan. Medicare Advantage Plans include: • Most Medicare Advantage Plans offer prescription drug coverage. .

How do I add drug coverage to my Medicare Advantage plan?

You can add drug coverage by joining a Medicare drug plan (Part D). Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you don’t need to join a separate Medicare drug plan. You can join a separate Medicare drug plan with certain types of plans that: You’re in a Medicare Advantage HMO or PPO.

Should I review my Medicare plan combinations?

What is the biggest disadvantage of Medicare Advantage?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

What is the most popular Medicare Advantage plan?

AARP/UnitedHealthcare is the most popular Medicare Advantage provider with many enrollees valuing its combination of good ratings, affordable premiums and add-on benefits. For many people, AARP/UnitedHealthcare Medicare Advantage plans fall into the sweet spot for having good benefits at an affordable price.

Does Medicare Advantage pay 80%?

Under Medicare Part B, patients usually pay 20% of their medical bills and Medicare pays the remaining 80%. Medicare Advantage, however, can charge patients coinsurance rates above 20%.

Can I be denied Medicare Advantage plan?

Generally, if you're eligible for Original Medicare (Part A and Part B), you can't be denied enrollment into a Medicare Advantage plan. If a Medicare Advantage plan gave you prior approval for a medical service, it can't deny you coverage later due to lack of medical necessity.

Can I switch from a Medicare Advantage plan back to Original Medicare?

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.

What are 4 types of Medicare Advantage plans?

Below are the most common types of Medicare Advantage Plans.Health Maintenance Organization (HMO) Plans.Preferred Provider Organization (PPO) Plans.Private Fee-for-Service (PFFS) Plans.Special Needs Plans (SNPs)

Do Medicare Advantage plans pay for hospitalization?

If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

How much should I expect to pay for a Medicare Advantage plan?

The average premium for a Medicare Advantage plan in 2021 was $21.22 per month. For 2022 it will be $19 per month. Although this is the average, some premiums cost $0, and others cost well over $100. For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

What is the maximum out-of-pocket for Medicare Advantage?

The US government sets the standard Medicare Advantage maximum out-of-pocket limit every year. In 2019, this amount is $6,700, which is a common MOOP limit. However, you should note that some insurance companies use lower MOOP limits, while some plans may have higher limits.

Why do doctors not like Medicare Advantage plans?

If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.

Which type of coverage may be excluded from a Medicare Advantage plan?

Non-medical services, including a private hospital room, hospital television and telephone, canceled or missed appointments, and copies of x-rays. Most non-emergency transportation, including ambulette services. Certain preventive services, including routine foot care.

What is a common reason for Medicare coverage to be denied?

Medicare's reasons for denial can include: Medicare does not deem the service medically necessary. A person has a Medicare Advantage plan, and they used a healthcare provider outside of the plan network. The Medicare Part D prescription drug plan's formulary does not include the medication.

How much is Medicare Advantage in Decatur?

When it comes to Medicare Advantage, most of the time you’re looking at a very low premium. Two of the four PPOs available in Decatur are $0 premium, another is $26 per month, and the last one is $117 per month.

Is Medicare Advantage a snowbird?

If you’re a snowbird, an HMO or PPO Medicare Advantage plan is not for you. A Medicare Advantage plan is going to have a list of in-network providers and hospitals, and they’re generally within a radius of your zip code.

What is original Medicare?

Original Medicare is the program managed by the federal government that includes Parts A and B. Part A is hospital insurance and includes care and services you receive when you are admitted as an inpatient to a hospital, skilled nursing facility, ...

Is there a limit to out of pocket costs for Medicare?

However, there is no limit to your annual out-of-pocket costs if you have Original Medicare.

Does Medicare Supplement cover copayments?

Some Medicare recipients with Original Medicare choose to supplement their coverage with a Medicare Supplement plan that can help cover some of the costs that Original Medicare does not , including copayments or coinsurance.

What are the areas of Medicare Advantage?

Areas of coverage that can be included within Medicare Advantage include (but not limited to) dental, vision, and hearing. These areas are not included within Original Medicare, so beneficiaries that want these areas will need to enroll in Part C.

How does Medicare work?

Medicare does this by dividing its coverage into four different parts.

What is Medicare Advantage Part C?

Part C of Medicare, or Medicare Advantage, is an alternative to Original Medicare. Compared to its counterpart, it offers substantially more coverage options. With these coverage options comes the ability for beneficiaries to select the areas of coverage they wish to be included within their policy. Areas of coverage that can be included within ...

Is Medicare for seniors?

Medicare is provided by the United States government and is primarily intended for seniors. While some can qualify before 65 based on disability, the majority of the coverage is aimed towards those in retirement. Enrolling in Medicare is a big decision, but is one that can save thousands of dollars each year.

Do Part C plans require care?

Some Part C plans typically require beneficiaries to receive care within a given provider network. This opens the possibility of beneficiaries saving money by using these in-network providers rather than going out-of-network. Being able to have network coverage is an excellent way to get care while ensuring that they’re covered within your policy.

IS MEDICARE ADVANTAGE THE SAME AS MEDICARE?

Medicare Advantage is a part of Medicare that offers an alternative to Original Medicare (Part A and B) plans. These plans, also known as Medicare Part C, combine Medicare Part A and Part B coverage and provide the opportunity to add additional coverage, creating better healthcare coverage for Medicare beneficiaries.

Advantages of Medicare Advantage Plans

Medicare Part C plans offer all the benefits covered by Original Medicare. However, many Medicare Part C plans provide more coverage. These benefits may include:

Disadvantages of Medicare Advantage Plans

With Original Medicare, you can generally go to any doctor or hospital that accepts Medicare and receive the same level of benefits for Medicare-covered services. Medicare Advantage plans, as mentioned previously, can have in-network providers and may require their members to use these networks to get care and treatment.

Is Medicare Advantage Right For Me?

When it comes to choosing the best Medicare plan, there is no one-size-fits-all solution. Medicare Advantage offers several benefits, such as multiple plan options and convenient coverage. However, it has its disadvantages as well, such as limiting network providers.

Dale Wondisford, Medicare Specialist

By submitting this form, I give licensed Medicare broker, Dale Wondisford, permission to contact me by phone, text and/or email. I understand that Dale Wondisford is a licensed insurance agent and he will contact me to give me information about Medicare Advantage Plans, Medicare Part D Prescription Drug Plans and/or Medicare Supplement insurance.

Why do you keep your Medicare card?

Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare. Below are the most common types of Medicare Advantage Plans. An HMO Plan that may allow you to get some services out-of-network for a higher cost.

What is MSA plan?

Medicare Medical Savings Account (Msa) Plan. MSA Plans combine a high deductible Medicare Advantage Plan and a bank account. The plan deposits money from Medicare into the account. You can use the money in this account to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.

Does Medicare Advantage include drug coverage?

Most Medicare Advantage Plans include drug coverage (Part D). In many cases , you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs.

What is Medicare Advantage Plan?

Medicare Advantage Plan (Part C) A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding hospice. Medicare Advantage Plans include: Health Maintenance Organizations. Preferred Provider Organizations.

What happens if you don't get Medicare?

If you don't get Medicare drug coverage or Medigap when you're first eligible, you may have to pay more to get this coverage later. This could mean you’ll have a lifetime premium penalty for your Medicare drug coverage . Learn more about how Original Medicare works.

How much does Medicare pay for Part B?

For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called your coinsurance. You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan (Part D), you’ll pay that premium separately.

What is the original Medicare?

Original Medicare. Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles). (Part A and Part B) or a.

Does Medicare Advantage cover prescriptions?

Most Medicare Advantage Plans offer prescription drug coverage. . Some people need to get additional coverage , like Medicare drug coverage or Medicare Supplement Insurance (Medigap). Use this information to help you compare your coverage options and decide what coverage is right for you.

What are the benefits of Medicare Advantage?

Most Medicare Advantage plans offer additional benefits not covered by Original Medicare, such as dental, vision and prescription drug coverage. Medicare Part D provides coverage for prescription medications, which is something not typically covered by Original Medicare.

What is an annual review of Medicare?

How long does Medicare AEP last?

The Medicare AEP lasts from October 15 to December 7 every year. During this time, Medicare beneficiaries may do any of the following: Change from Original Medicare to a Medicare Advantage plan. Change from Medicare Advantage back to Original Medicare. Switch from one Medicare Advantage plan to another.

What is Medicare Part B?

Medicare Part B is medical insurance and provides coverage for outpatient appointments and durable medical equipment. Part B is optional, but is required for anyone wanting to enroll in Medicare Part C, Part D or Medicare Supplement Insurance. Part A and Part B are known together as “Original ...

Is Medicare Part A and Part B the same?

Part A and Part B are known together as “Original Medicare.”. Medicare Part C, also known as Medicare Advantage, provides all the same benefits as Medicare Part A and Part B combined into a single plan sold by a private insurance company.

What’s Your Budget?

Do You Travel?

Do You Take Prescriptions?

Do You Want to Keep Your Current Doctor?

Are You Interested in “Extras”?

What’s Your Risk profile?

What’s Right For You?

At this point, you might have a clear understanding of whether or not a Medicare Advantage plan is right for you. If you’re interested,don’t hesitate to give us a call at 217-423-8000. If you’re still unsure and want to consult with an agent, that’s what we are here for! Please give us a call or schedule an appointment using our online system! Fina...

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