Tips for Choosing the Right Medicare Advantage Plan


An important Medicare deadline is approaching for seniors: The Medicare Annual Enrollment Period will begin October 15, 2016 and end December 7, 2016. If you need to enroll in a Medicare Advantage or prescription drug, change an existing plan, move to a new one or dis-enroll now is the time to take action.

Steve Zaleznick, Senior Medicare Adviser of PlanPrescriber, a website that provides free comparison tools and educational materials for Medicare-related insurance, says the big challenge for Medicare beneficiaries and their advisors is to make a plan selection that fits their needs and is sufficiently flexible to cover any unknowns the upcoming year might bring.

Tips for choosing a Medicare Advantage Plan

For some seniors, it makes sense to consider a Medicare Advantage Plan. The premiums are usually lower than the combined cost of having traditional Medicare, a Medicare Supplement plan (such as Medigap) and a Part D drug plan. But the key is to understand your needs and know what you are buying, Mr. Zaleznick says.

Here are 7 things to consider during your decision-making making process:

What is Medicare Advantage?

Medicare, the traditional health care benefit for seniors provided by the government, has coverage gaps and puts no cap on what a beneficiary could spend. Indeed, approximately of 20 percent of physician fees are paid by the beneficiary, according to Mr. Zaleznick. A Medicare Advantage Plan (such as an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies that have been approved by Medicare.

Medicare Advantage Plans vs. Medicare Supplement Plans

A Medicare supplement covers gaps in Medicare, but does not cover prescription drug costs. You would need to enroll in a separate Medicare drug plan to get that benefit. Medicare Supplement plans tend to provide more "first dollar" coverage when you require medical care. Because Medicare Advantage Plans often include a prescription plan, it may offer more encompassing coverage. Known as MA-PD, Medicare Advantage Plans still have deductibles and co-payments, but the maximum that a beneficiary will pay out-pocket, other than for drugs, is capped.

Look at Out-of-Pocket Expenses

Whether or not you need a Medicare Advantage Plan depends on how much out-of-pocket expense you are willing to take on. A good place to start is by analyzing how much money you've spent on health coverage not covered by Medicare over the last few years, including the amount you've spent on premiums, co-pays and deductibles.

Is Your Preferred Doctor in In-Network?

If you want to continue seeing your doctor, check beforehand that he or she is an in-network provider for the Medicare Advantage Plan you are considering.

Check Your Medications

Review your medications and see if they are covered by a particular plan, or not. Visit the Drug Cost Calculator tool on Plan Prescriber's website to check the medications you take.

Consult Local Experts

Rates and benefits differ widely among plans and states. Talk to someone who knows the regulations and nuances in your area.

Check Your Plan Yearly

Coverage rules and plan options change regularly and the plan you have this year may not be the optimal one for you next year as well. During the Annual Enrollment Period, revisit your choices from last year and consider other plans that might better fit your needs.

"An increasing number of Baby Boomers are now enrolling in Medicare for the first time. As they begin to understand the different types of Medicare coverage available, and the specific Medicare enrollment periods that correspond to each coverage type, the enrollment dates become even more important," Mr. Zaleznick says. "Procrastination is not your friend. Doing nothing is not the answer."

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All good advice. There is another problem I am sure others have to deal with. One spouse, with family health plan turning 65, while the other spouse won't be 65 for another year. Medicare options only available for first 7 months then not obtainable, after turning 65. Separate medical plans outrageous with high premiums & deductibles. Now what?

"Now what?" Now -- from Medicare's point of view -- you are no longer married. Doesn't matter that the two of you turn 65 at different times. No such thing as a family plan.

(It is not true that "Medicare options are available for first 7 months and then not obtainable." I think you are mixing up two rules.
1. You can sign up for Original Medicare Parts A and/or B no questions asked with no penalties involved in a seven-month window either side of your 65th birthday month. If you want to sign up later there may still be no penalty depending on whether you had other insurance but there are complicated rules. But you can always sign up for Original Medicare later and pay the penalty if you don't meet these rules; it is always obtainable
2. You can sign up for a private Medicare supplement, called a Medigap plan, no questions asked and without penalty (such as it being unobtainable) for six months after you sign up for B if you were allowed to delay signing up for B under the complicated rules mentioned in point 1.
In my opinion, this overcomplicates the difference between private Medigap and public Part C Medicare Advantage plans. Especially for those of us under 70, think of it this way
-- Medigap along with Original Parts A and B is like the old Blue Cross Master Medical we all got when we first started working
-- Medicare Advantage along with Original Parts A and B is like the HMOs and PPOs our employers starting pitching as lower cost choices in the 1980s (and in some cases, later made the only "choice")

I assume the people who write Medicare advice columns like this overcomplicate this difference with all the mind-numbing Medicare bureaucracy rules because they are young and do not understand that we people on Medicare have buying insurance of all types for 50 years.