Medicare Advantage plans get advertised heavily, especially during the Medicare Annual Enrollment Period from October 15 through December 7.
You hear about the low or even $0 monthly premiums and all the extra bells and whistles, but how do you decide if a Medicare Advantage plan is right for you?
In this video, we’ll go through step by step how to figure out if a Medicare Advantage plan is the right Medicare coverage option for you.
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To…
Step 1: Look at what’s available in your county.
Medicare Advantage plans vary, not just from state to state, but from county to county. The first thing you need to do is find out which Medicare Advantage plans are in your county.
This really varies. In some counties, there are tons of Medicare Advantage options and most medical providers contract to be in the networks of many of them. In other counties, there are only a few Medicare Advantage options and few providers are in network.
Step 2: Check the plan networks for your medical providers.
Once you know which Medicare Advantage plans are in your county, check those plans to find which ones have your doctors, hospitals, and other medical providers in their networks.
If few or none of your providers are in plan networks, and you don’t want to change doctors or hospitals, then, a Medicare Advantage plan is not the best option for you.
If that’s the case, I recommend looking at Medicare Supplements in your area. They have no network restrictions. You are free to go to any medical provider who accepts Medicare. The one exception to that is for Medicare Select plans, which are explained here: https://youtu.be/aYrOjOZPckM
If there are plans with your providers in network, you can move on to…
Step 3: Find out how your medications are covered.
If you’ve narrowed the plans to those that have your providers in network, it’s time to learn how each of those plans covers your prescription medications.
Don’t get too hung up on the prescription deductible or out of pocket max or drug tiers. What’s important is the annual total estimated cost and the monthly cost breakdown for the medications you actually take.
Step 4: Estimate your health spending for each plan for the year.
Medicare Advantage plans usually have pretty low monthly premiums, which are the charges to remain enrolled in the plan. Many Medicare Advantage plans have $0 premiums.
The costs for these plans kick in if and when you use medical services. If you have office visits, surgeries, hospital stays, physical therapy, or any other medical services, you will pay a copay or coinsurance amount.
All of the plan copays and coinsurance amounts for covered services can be found in the plan’s Summary of Benefits and Evidence of Coverage documents. Go through those to estimate how much you will likely be spending for your medical services through the year.
When you are making this estimate, also take a look at what the absolute worst case scenario could be. Every Medicare Advantage plan has an annual out-of-pocket maximum. That is the most that you can spend during a year for your medical care for covered services.
The out-of-pocket max is not the same from plan to plan, so keep that number in mind when you are comparing plans too.
Step 5: Compare the numbers from Step 4 to the cost of a Medicare Supplement.
Medicare Supplements, also known as Medigap plans, for the most part, have higher monthly premiums than Medicare Advantage plans but low or no charges when you receive medical services.
If you have a serious, chronic health condition that requires many office visits and treatments, paying the monthly premium for a Medicare Supplement could be less expensive than paying Medicare Advantage copays and coinsurance for all of your medical services through the year.
On the other hand, if you make very few office visits and have no ongoing health conditions that require regular treatment, paying a higher premium for a Medicare Supplement will end up being much more money out of your pocket than you would pay in a Medicare Advantage plan.
Step 6: What plan are you most comfortable with?
The two main routes open for Medicare coverage for most people are Medicare Supplements or Medicare Advantage plans.
With a Medicare Supplement, you pay a predictable amount every month as a premium and have very low extra costs through the year when you receive medical care.
With a Medicare Advantage plan, that situation flips. You have low or no monthly cost to be enrolled in the plan but have costs every time you have medical treatment.
If one of those options is going to cause you stress, then that’s not a good fit for you. We can go through all the math for all the options, but at the end of the day, you make the decision and choose the plan you can live with most easily.
Have Questions? We Can Help!
You can go through all of these steps on your own, but there is an easier way. A Medicare plan broker can take all of your information and do the comparison shopping for you.
We work with these plans every day and know the ins, outs, positives, and negatives of all of them. We can answer all of your questions and give you enough information to make an informed decision and enroll in the best plan for you.
And all of that help is at no cost to you. We’re also around to help you if any questions or issues come up during the entire life of your policy and to do the comparison shopping again in future years.
If you have questions about Medicare Advantage plans, or any other questions about your Medicare coverage, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation.
We’re here to help you find the best possible Medicare coverage option for your unique situation!
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