Understanding Medicare Advantage Plans

It’s important for you to know that Medicare doesn’t allow any Medicare Advantage plan to call itself the “best Medicare Advantage plan.” That’s because there are different networks, benefits, costs, and lists of covered medications. What is best for you is likely different than what is best for your neighbor.

If you like your current plan and don’t mind its upcoming changes, you are set and don’t need to do anything. If not, we suggest shopping around to see if you can find something that will better fit your needs and income.

Different than Medigap

You may have heard Medicare Advantage plans referred to as Medicare replacement plans. This term can kind of be misleading. While these plans don’t permanently replace your Medicare benefits, it’s accurate in the sense that members of Advantage plans get their benefits from a private insurance company instead of Original Medicare.

When you enroll, it’s typically for the rest of the calendar year. You may not be able to disenroll mid-year unless you have a special circumstance.

Lower Premiums, But Networks

These plans often have lower premiums than Medigap plans. There can even be $0 premiums on some plans in specific areas. In exchange for the lower premiums, you have a different set of rules to abide by than those on Original Medicare.

For example, your plan will have a network of providers. The two most common network types are HMO and PPO networks, and we’ll discuss these below.

Convenient Extras

Since these insurance companies are private, they can offer extra benefits such as dental, vision, or hearing. Some even offer free gym memberships.

These are benefits you will not find in Original Medicare or a Medigap plan. These ancillary benefits are one reason why some individuals feel like Medicare Advantage is the best fit for them.

What to Look for When Comparing Medicare Advantage Plans

The advantage to Advantage Plans (yes, the pun was intended there) for most people are the lower premiums. However, some beneficiaries may choose a plan because of its network or drug formulary or its extra benefits. The plan that’s best for your neighbor isn’t necessarily the best for you.

We’ve made a list of the main questions to consider while comparing plans.

What is the Medicare Advantage Plan’s Star Rating?

Medicare has a five-star rating system in which it rates Medicare Advantage plans. Why are Medicare star ratings important? Well, the rating evaluates things such as customer satisfaction and quality of care from plan to plan.

Most people tend to select a plan with 3.5 stars or more, and this is probably wise. There’s very likely a good reason that the plan got the star ratings that it did. It can provide you with peace of mind to choose a plan that many other beneficiaries have expressed satisfaction in.

Plans with the top ratings of four or five stars get additional funding from the government to spend on your medical benefits. These bonuses go toward providing you with extra benefits, and this is a win-win for everyone.

Are your doctors in the plan’s network?

When my team researches MA options for our clients, the first thing we do is check to see if the plan’s network includes the client’s important doctors. We check the plan’s online directory and we confirm with the doctor’s office as well.

Each Medicare Advantage plan will have a network of providers in the location where the plan is based. Most Medicare Advantage plans have HMO or PPO networks. Medicare HMO plans are the most prevalent type of MA and for them to pay your claims, you usually must be seen by a provider in that network.

Medicare PPO plans will allow you to see doctors outside of the network, but your out-of-pocket expenses will be substantially higher. The out-of-network doctor must also be willing to bill the plan.

Does the Medicare Advantage plan offer extra benefits?

As we mentioned earlier, some Advantage plans come with added dental and vision coverage or even a gym membership benefit. We often get calls from beneficiaries that only want a plan if it offers a gym membership such as Silver Sneakers.

Though these extras are enticing, you should always make your decision based on your medical needs, first and foremost. Should the plan that fits your medical needs also offer benefits like Silver Sneakers, it may be a great fit for you.

Sign Up For Medicare

We understand that Medicare matters can get quite complicated. It is better to get help understanding Medicare before you sign up for a plan. With our help, you will have in-depth health insurance knowledge of the benefits offered by basic and supplement plans.

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