Medicare Advantage plans offer insurance through private insurers that contract with Medicare. This means that beneficiaries get similar services to original Medicare enrollees, but may also get additional coverage. For example, many Medicare Advantage plans cover vision and dental care or prescription drugs.
If you're helping your loved one shop for a Medicare Advantage plan, the following strategies can help you choose the right insurance.
Identify Medical Needs
Before you begin shopping for a plan, consider your loved one's current medical needs. List their medical providers and any medications they take. It's also helpful to estimate how much they are currently spending on healthcare so that you can find a plan that reduces these costs.
As you discuss these needs, ask your loved one:
- Do you like your doctor, or do you want to switch?
- Do you think you might need to see a new specialist in the coming year? Do you have a specific specialist in mind?
- How do you feel about choosing providers from a limited pool in a health maintenance organization (HMO)? Are you willing to choose from fewer providers to save money?
- Do you want vision or dental coverage? How much more are you willing to pay for this?
- What is the most you can afford to pay each year in medical expenses?
- How much can you afford each month in monthly premiums?
Compare Plan Options
When comparing plans, it's important to review all of your options, including original Medicare. For some beneficiaries, the original program may be a better or more affordable option. If your loved one chooses Medicare Advantage, there are still numerous plans to choose from. The most common Medicare Advantage plan structures include:
- Health maintenance organizations (HMOs): With an HMO, you pay lower premiums, but can only seek care from a specific network of providers. If you use a doctor outside of this network, it's usually not covered.
- Preferred provider organizations (PPOs): With a PPO, you get a discount for choosing a provider within the plan's network. Your co-pays will be higher if you go out-of-network.
- Special needs plans (SNPs): Special needs plans cater to a group of people with specific needs, such as those with a particular disability or people living in residential care settings. As with an HMO, you usually have to seek care within the plan's network.
Narrow your options down to plans with a five-star rating, then review the specific terms of each plan.
Read Plan Documents
Once you have a list of a few potential plans, review the specific terms of each plan. Some important things to look at include:
- The plan's monthly premiums
- Co-pays for the services your loved one is most likely to use. In many cases, you'll save money by paying a slightly higher premium for lower co-pays.
- The annual out-of-pocket maximum
- The specific services the plan covers, such as vision, dental care, or prescription drugs
- Whether your loved one's doctors accept the plan or are in its preferred provider network
- Whether the plan covers the specific medications your loved one uses