Medicare Advantage plans vary. There are important things to consider when you compare Medicare Advantage plans. In addition to premiums, you need to consider what you get for your premium and how much it is going to cost you when you go to the doctor. This article highlights some of the things to consider when choosing a plan.
Medicare Advantage Plans
The first thing you will notice when you compare Medicare Advantage plans is that at the minimum, all Medicare Advantage plans (MA) have the same coverage as the found in both parts of Medicare (Part A and Part B). With that said, there are many types of MA plans (HMO, PPO, etc.) available to you.
So this is the question you need to answer: Is a plan correct for you?
Here are three areas to consider.
- Medical Care – Choosing your doctor, access to specialists, treatment approval, etc.
- Costs – The premiums, co-payments and total cost
- Addition benefits – Eye care, dental, etc.
- Prescription coverage – Included, or use part D?
Compare Medicare Advantage Plans by Medical Care
Doctor and Provider Choice
Most Medicare Advantage plans include a network of Doctors and providers. You probably have doctors and providers that you trust. Find out if your is in the plans network. In the case of fee-for-service plans, find out if your provider accepts the plan’s terms.
Service Area
Each plan has a service area. A service area is a geographic area. Make sure that there are enough specialists in the area covered by the plan. The lack of specialists may limit your health care.
Also, a plan may offer an extended service area. This is important if you travel often and leave the plan’s geographic area. An extended service area makes it possible to take care of non-urgent medical needs when you are not in the primary service area.
Access to Specialists
For some plans, you must visit your primary care physician (PCP) before you can see a specialist. The PCP must refer you to the specialist. You cannot go to the specialist on your own.
To find out how difficult it is to get a referral, ask your doctor about their experiences with the plan.
- Does the plan often overrule the PCP?
- Does the plan have strict guidelines for the doctor to follow?
- If your medical condition requires specialists, does your plan let you see those specialists without PCP approval?
Treatment Approval
For Medigap plans, if Medicare covers the treatment, approval is automatic. In Medicare Advantage plans, treatment my be denied if:
- Deemed medically unnecessary,
- If a different, cheaper alternative is available, or
- If the treatment is experimental.
Alternative Medicine
Medicare pays for a very limited amount of chiropractic care. Medicare does not pay for acupuncture or acupressure treatments. Some Medicare Advantage plans pay for some of the costs.
After-Hours Medical Care
Sometimes you need medical care when the doctor’s office is closed. This may mean a trip to the emergency room. This is usually a costly, unpleasant and unnecessary experience.
Some plans offer a 24 hour nurse line. An experience nurse can tell you if an ER visit is necessary or not. Also, some plans may keep after hours clinic which you can visit.
Wellness Program
Some plans offer programs to help you lead a healthier life. These include nutrition and exercise programs.
For people with chronic diseases, some plans offer disease management programs. These programs help by monitoring and managing chronic conditions.
Compare Medicare Advantage Plans by Costs
When you compare Medicare Advantage plans, you will find plans with low premiums. You can find a HMO that provides low-cost or no premiums for basic Medicare Part A and B coverage. But, you still have to pay the part B premium. This may seem like a good deal, until you consider the co-payments.
Most Medicare Advantage plans charge co-payments. Every time you visit a doctor you pay a co-pay. If you have drug coverage in your MA plan, you will be paying a co-pay there also.
So, it is important to check the total cost. The total cost is the premium plus any anticipated co-pays.
Another thing to note is that Medicare Advantage plans may change the coverage at any time. They are also free to change the charges at anytime.
Compare Medicare Advantage Plans by Benefits
You need to consider other benefits when you compare Medicare plans. Many plans offer a variety of other benefits beyond Medicare:
- Emergency medical care while traveling overseas
- Short term custodial care following an injury, surgery or serious illness.
- 100% coverage of medical equipment such as wheel chairs, hospital beds, etc.
- Eye exam coverage and eyeglass discount
- Hearing exam coverage and hearing aid discount
- Discounted dental work
Prescription Drugs
Some Medicare Advantage health plans include prescription drug coverage. You can chose such a plan, or have a stand-alone Part D drug plan. The things to consider in a prescription drug plan are:
- Does the list of drugs covered include the drugs you regularly take?
- Does the plan restrict access to those drugs?
- Are the co-payments reasonably low?
Medicare Advantage Plan Maze
To compare Medicare Advantage plans is like navigating a maze. Fortunately, there are state agencies to help you. These programs are called either the State Health Insurance Assistance Program (SHIP) or known as the Health Insurance Counseling and Advocacy Program. Local staff within your state can help you compare plans and policies.