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5 Questions To Ask Before Enrolling In Medicare Advantage

By Zawn Villines
Before choosing a Medicare Advantage plan, you should understand the different types of plans available, as well as your health needs. Asking important questions can help guide your decision.

Medicare Advantage is private health insurance accessed through the Medicare system. This flexible option allows you to choose the plan that works for your needs. You can often get more services than traditional Medicare offers, including vision, dental, and prescription drug benefits. But this doesn't mean Medicare Advantage is right for everyone. Before enrolling in Medicare Advantage, these questions can help you decide which plan is the best fit for you.

What specific services are covered?

Medicare Advantage, like original Medicare, has to cover most basic health care. But it's important to read plan documents so you know exactly what is covered. Identifying your own unique health needs can help you decide which plan is best for you.

Some Medicare Advantage plans, for example, cover vision or dental care. If you have a history of complex dental or eye health issues, or have reason to believe you will soon need extensive care, it makes sense to choose a plan that includes these services.

Is my doctor included in the plan?

Some people are happy to see any friendly, well-trained doctor. Others prefer a specific care philosophy, or have spent years forming a close relationship with providers they trust. If you like your doctor and can't imagine switching to another provider, choose a plan that includes them.

It can also be helpful to assess how many doctors are included in the plan, and whether you'll pay more if you go out-of-network. Health maintenance organizations (HMOs) only cover services within the insurer's network. If there are only a few doctors in-network, you might have more trouble finding a clinician you like.

Does the plan include prescription drug coverage?

Original Medicare does not cover prescription drugs. Many Medicare Advantage plans do. Make a list of your current prescription drugs, as well as any prescription drugs you think you might need in the next year. Then compare this to the list of the drugs the plan covers. Coverage levels may differ according to drug type and class. For example, a plan might fully cover generics, but only offer partial coverage for newer brand-name pills.

Which type of Medicare Advantage plan is right for me?

Medicare Advantage offers several different types of plans, including:

  • Special needs plans, which cover people with specific, defined illnesses or conditions. 
  • Health maintenance organization (HMO) plans, which cover services only with in-network providers.
  • Preferred provider organization (PPO) plans, which offer discounts if you choose an in-network provider.

The right plan depends on your health needs, the types of doctors you see, whether a plan covers your doctor, the cost of premiums, and other related factors.

What is the plan's rating?

Medicare assigns a rating to each Medicare Advantage plan. You can view ratings and compare plans using the "Plan Finder" tool on The Official U.S. Government Site for Medicare online. Select a 5-star plan to get the highest quality coverage. You may also want to expand your research. Consider searching for the plan online to read consumer reviews. If friends or family enrolled in Medicare Advantage, ask about their experiences, including whether they would enroll in their plan again.