Choosing a Medicare Advantage Plan

If you choose to get your Medicare coverage from a Medicare Advantage Plan, it is important to choose the specific plan that works best for you. Plans vary a lot and can change every year, so it’s a choice you should make carefully and reevaluate each year.

 

What is Medicare Advantage?

• Medicare Advantage Plans contract with the federal government to provide Medicare benefits. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare.
• Medicare Advantage Plans must offer, at minimum, the same coverage as Original Medicare but can do so with different rules, costs, and restrictions.
• You usually get Part D prescription drug coverage as part of your Medicare Advantage Plan. You may pay a monthly premium for this plan, in addition to your Part B premium.
• Many plans also cover some things that Original Medicare cannot, called supplemental benefits. Common examples include dental and vision coverage, gym membership, or an over-the-counter card.

 

Use Medicare’s Plan Finder tool to compare plans

Medicare Plan Finder is an online tool that you can use to compare plans in your area. The tool shows you plan information like what medications are covered, what costs there are like premiums and deductibles, the star rating of the plan, and more. To use Plan Finder, go to www.Medicare.gov and select “Find Plans Now.”

 

Keep the following questions in mind

Health care providers:

• Are my doctors in the plan’s network?
• Which hospitals and nursing facilities by me are in the plan’s network?
• If they are not in network, will the plan still cover me but at a higher cost?
• Do I need to get a referral from my primary care provider to see specialists?

 

Costs:

 How much are the plan’s premium, deductible, and copays?

• What is the plan’s maximum out-of-pocket cost?
• How much will I pay if I see an out-of-network provider?

 

Prescription drugs:

• Does the plan cover my medications?
• Are there coverage restrictions on those medications?
• How much will those drugs cost?
• Is my pharmacy in network?

 

Supplemental benefits:

• Does the plan offer additional benefits not covered by Original Medicare?
• What are the costs associated with this benefit?
• Are there any restrictions or rules I need to follow for this coverage?

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