Whether you are shopping for a Medicare Advantage plan for the first time or are contemplating switching from your current plan, it may be difficult knowing which one is best. There is really no single plan that will be best for every single person. The following tips will provide some reliable pointers on how you can choose a plan that works for you.
1. Reviews and Ratings
Nothing is stopping you from doing the long and hard work needed to evaluate each and every Medicare Advantage plan. But the amount of time and knowledge required to do that is simply out of reach for the majority of people. Fortunately, you can benefit from the research that those with a much deeper understanding of Medicare have already done.
For example, Health.com spent more than 100 hours studying the best Medicare Advantage plans and came up with a final shortlist of six. You could also check out the Centers for Medicare and Medicaid Services (CMS) star rating system. Here, Medicare Advantage plans are assigned a star rating depending on how well they score on multiple factors. These include pricing, accuracy, safety, performance, tests, screenings, vaccines, complaints and customer service.
2. Determine Your Preferences and Priorities
All Medicare Advantage plans cover the same thing that Medicare Part A and Part B do (both hospital/inpatient coverage and medical/outpatient coverage). To choose the right plan, therefore, you have to establish what additional coverage you require above these core areas.
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Extras include prescription drugs, dental procedures/exams, vision exams/devices, hearing exams/devices, medical transportation and fitness memberships. Think about what services and perks you consider most important, and then look for the Medicare Advantage plans that offer them to you.
3. Determine Your Health Needs
As you think about the items you want the plan to cover, don’t lose sight of your long-term health needs. This is, after all, the primary reason you need a Medicare Advantage plan. If you have a preexisting chronic condition or are a frequent traveler, these can contribute to your choice of plan.
Certain plans are well-suited for the care of illnesses such as kidney disease, bladder conditions, diabetes, osteoporosis, high blood pressure and rheumatoid arthritis.
4. Identify the Most Suitable Plan Structure
There are five types of plan structures. First, the Health Maintenance Organization (HMO) plans that are built around in-network coverage of health care services. Second, Preferred Provider Organization (PPO) plans that levy different rates, depending on whether services are accessed in or out of network.
Third, Private Fee-for-Service (PFFS) plans that permit patients to obtain health care services from any Medicare-approved provider that accepts the plan’s approved fee. This makes such plans ideal for frequent travelers and patients who need access to out-of-network providers.
Fourth, Special Needs Plans (SNP) that provide support for costs incurred from managing specific chronic illnesses such as end-stage renal disease (ESRD). Fifth, Medicare Medical Savings Account (MSA) plans that combine a high deductible health plan with a medical expenses savings account.
5. Assess Your Budget
The premium you’ll need to pay for Medicare Advantage cover varies from plan to plan. They can range from $0 to more than $1,500, depending on the benefits available. While a $0 plan would seem extremely budget friendly, you have to delve into the details to find out if it really saves you money.
Evaluate each plan you are considering not just by the monthly premium. Take a look at the Part B premium, drug deductible, in-network annual deductible, out-of-pocket caps, copays and coinsurance options, too. Gauge these costs in the context of how often you expect to visit the doctor, refill your prescription drugs or see an out-of-network specialist.
Wrapping Up
Multiple factors determine which Medicare Advantage plan is most suitable for you. Take your time shopping for a plan so you don’t have buyer’s remorse just a few months after signing up.
