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Understand Your Options
A Medicare Advantage Plan, sometimes referred to as Medicare Part C, is a Medicare-approved plan offered by a private insurance company. Medicare beneficiaries who wish to enroll in a Medicare Advantage Plan have a number of choices available to them. These include: plan provider, type of plan, and optional covered services, such as vision, dental, and prescription drug coverage.

There are a number of providers that offer Medicare Advantage Plans in various areas. How many providers offer plans in your area, and how many individual plans are offered, will depend on your county of residence. Most Medicare beneficiaries will have access to at least 10 different Medicare Advantage Plans.

There are several different types of Medicare Advantage Plans. The most common type of plan is a Health Maintenance Organization (HMO) plan, which covers more than 50% of Medicare Part C beneficiaries. Preferred Provider Organization (PPO) plans and Private Fee-for-Services (PFFS) plans are the next most common. Less common options include Special Needs Plans (SNP), HMO Point-of-Service plans and Medical Savings Accounts.

Typically, Special Needs Plans are run as HMOs. They are available only to Medicare beneficiaries who meet specific requirements, which include: a need for institutional care, a diagnosis of one of several specific types of chronic medical conditions, and/or dual eligibility for both Medicare and Medicaid due to low income or limited resources. The most common type of Special Needs Plan is for Medicare beneficiaries who also qualify for Medicaid.

Decide What’s Most Important
The various types of Medicare Advantage Plans all have their own benefits and downsides. Deciding what is most important to you is the first step in determining which plan will best suit your needs. Do you require a particular kind of care? If so, you should find out how much your required medical service will cost you under the different plans available in your area. Do you have a favorite doctor you want to keep? Verify that he or she is a Medicare provider and accepts a particular type of plan before you enroll.

Do you want to have easy access to medical specialists? Some plans, such as Health Maintenance Organization plans, may require you to obtain a referral from your primary doctor before you can visit a specialist. Failure to do so may mean you have to pay for the specialist’s services out of your own pocket. While Private Fee-for-Services plans do not require referrals to specialists, not every Medicare provider accepts this type of Medicare Advantage Plan. If you choose to enroll in a PFFS plan, you may have to spend some time searching for the Medicare providers in your area who will accept it.

Do you need to visit a number of different doctors on a regular basis? Some plans (such as Preferred Provider Organization plans) may require you to pay higher out-of-pocket costs if your Medicare providers are considered out-of-network. Make sure that the plan you choose offers access to a number of in-plan Medicare providers in your area.

Figure Out Which Plans You Can Afford
Cost is often a big factor in determining which healthcare plan will best suit a person’s needs. Unfortunately, figuring out how much a Medicare Advantage Plan will actually cost you each year can be tricky. While many people think it is best to pick the plan that costs the least amount each month, a plan’s premiums are not the only factor to consider. Lower monthly premiums often mean a higher yearly deductible, which must be met before the plan picks up any of your healthcare expenses.

Other costs you may be required to pay include copays for each doctor or hospital visit and/or a certain percentage (called coinsurance) of the bill for each medical service you obtain. The copay and coinsurance amounts can vary significantly between Medicare Advantage Plans, particularly for plans that include prescription drug benefits. If you fill prescriptions frequently and/or are prescribed a number of different medications, take some time figuring out which plan will save you the most money at your pharmacy every month.

The amount you are required to pay for the same medical service can also vary widely between Medicare Advantage Plans. To determine whether you can afford a plan, you should determine which medical services you use the most (labs, x-rays, chemotherapy, dialysis, etc.), and find out how much you would be required to pay out-of-pocket for those services under the different plans. Remember: If the plan includes a yearly deductible, you will often be required to pay 100% of your medical bills (excluding simple visits to the doctor) yourself until the deductible has been met. Further, yearly deductibles can vary significantly between plans and can range from zero dollars to thousands of dollars.

Under the 2010 health care reform bill, all Medicare Advantage Plans must include an annual out-of-pocket maximum for beneficiaries. This is the total amount you can be charged out-of-pocket per year for medical services. While the Centers for Medicaid & Medicare Service has encouraged providers to keep the annual maximums below $3,500, some plans may have maximums set significantly higher. If you are worried about unforeseen, high-cost medical emergencies, it may be worth your time to consider each plan’s out-of-pocket maximum in your decision.

Enroll in the Plan That Best Fits Both Your Needs and Your Budget 
Your Medicare benefits are important to your day-to-day well being. Take the time to compare Medicare plans before deciding on coverage. For assistance with finding a Medicare Advantage Plan in your area, visit www.medicare.gov/find-a-plan or call 1-800-MEDICARE (TTY 1-877-486-2048).