Tips for selecting a Medicare Advantage Plan

Medicare beneficiaries aren't locked into receiving their benefits from the government. Instead, individuals can elect to enroll in Medicare Part C, otherwise known as Medicare Advantage. These plans offer the same coverage as original Medicare plus additional benefits such as dental, vision or hearing services. Most Medicare Advantage plans also include Medicare Part D which pays for prescription drugs.

Since Medicare Advantage is offered through private health insurance companies, coverage and costs can vary. Beneficiaries should carefully weigh their options to ensure they are selecting the right plan for their needs.

Types of Medicare Advantage plans

Just like other medical insurance, Medicare Advantage is offered through several types of plans. According to the Centers for Medicare & Medicaid Services, Medicare Part C is available in the following forms:

  • Health Maintenance Organizations (HMO)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service Plans (PFFS)
  • Special Needs Plans (SNP)
  • HMO Point of Service Plans (HMOPOS)
  • Medical Savings Account Plans (MSA)

Leeba Leesin is the president of CareMore which offers Medicare Advantage plans in California, Nevada and Arizona. Leesin suggests beneficiaries with chronic conditions may want to consider SNPs which are designed with specific health needs in mind.

"For example, a Medicare SNP may be designed to serve only people diagnosed with diabetes," said Leesin. "Examples of benefits may include zero cost sharing or discounted prescriptions as well as programs to manage wound care, hypertension and/or nutrition."

Tips for selecting the right Medicare Advantage plan

Beneficiaries should be aware that each type of plan has its own cost-sharing structure as well potential restrictions on which providers and health care facilities a patient can use. For example, HMOs may require a referral to see a specialist while PPOs may charge beneficiaries larger co-payments for providers outside their network of approved physicians.

"Make sure you understand how a plan works before you join," said Leesin. "Make sure there is a doctor and hospital included in the plan's network that would be easy for you to access."

In addition, Leesin offers the following tips to Medicare beneficiaries as they consider various Medicare Advantage plans:

  • Consider a plan's total cost including premiums, co-payments, co-insurance and out-of-pocket maximums.
  • If a Medicare Advantage plan includes prescription drug coverage, confirm current prescriptions are covered by the plan and review any required co-payment costs for those specific medications.
  • If a beneficiary has plans to travel, review what urgent care options are available outside a plan's normal service area.
  • Take into consideration whether additional benefits are provided in the plan such as vision and dental care.

"Make sure to do your homework," said Leesin. "Once you pick your plan, you can only join or leave a plan at certain times during the year."

Beneficiaries can visit the Medicare website for assistance in selecting the right health insurance plan. The Medicare Plan Finder allows visitors to compare plan benefits and costs. In addition, help may be available by calling the Medicare hotline toll-free at 1-800-MEDICARE.

Article sources  expand

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