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Review all 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 options to choose from, including plan provider, type of plan, and optional covered services, such as vision, dental, and prescription drug coverage.
The number of providers that offer Medicare Advantage Plans varies in each county. Almost all Medicare beneficiaries have access to at least one Medicare Advantage plan. In 2013, beneficiaries in nearly every county will be able to select from an average of 26 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 percent of Medicare Part C beneficiaries. Preferred Provider Organization (PPO) plans and Private Fee-for-Services (PFFS) plans are the next most common, followed by Special Needs Plans (SNP), HMO Point-of-Service plans, and Medical Savings Accounts. Different Medicare Advantage Plans offer a variety of plan-specific benefits, so it is important to compare plans to find out which one is best suited for you.
Decide what benefits you want based on your health care needs
Because Medicare Advantage Plans are offered by private companies, there are a number of differences between the plans, including cost, additional coverage, and rules for obtaining services. Deciding what benefits are 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, such as vision 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.
- 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 not in their network. Make sure that the plan you choose offers access to a number of in-network Medicare providers in your area.
- Do you take a lot of prescription drugs? You may want to consider a Medicare Advantage Plan that also offers prescription drug coverage (MAPD plan) rather than enrolling in a separate Part D prescription drug plan (PDP).
Determine 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 some people think it is best to pick the plan that has the lowest monthly premium, a plan's premium is 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. Yearly deductibles can vary significantly between plans and can range from zero dollars to thousands of dollars.
In addition to premiums and deductibles, you may have to pay a copayment for each doctor or hospital visit and/or a certain percentage (called coinsurance) of the bill for each medical service you obtain. The copayment 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 to find 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. That's why it is important to make a list of all the 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 percent of your medical bills (excluding simple visits to the doctor) until the deductible has been met.
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 Services has encouraged providers to keep the annual maximums below $3,500, some plans may have maximums set much 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).