Dear wise senior,
I will be 65 and eligible for Medicare in a few months and want to purchase a Medicare Advantage plan to cover my health care and medications. What advice can you give me to help me choose a plan?
Ready to retire
Medicare Advantage plans have become very popular among retirees over the past 15 years, as nearly half of all new Medicare enrollees enroll in Advantage plans, which represent approximately 42% of the entire Medicare market. Here are some tips and tools to help you choose a plan that meets your needs.
First, let’s start with a quick review. Medicare Advantage plans (also known as Medicare Part C) are government-approved health plans sold by private insurance companies that you can choose instead of Original Medicare. The vast majority of Advantage plans are managed care policies such as HMOs or PPOs that require you to obtain your care within a network of physicians.
If you enroll in an Advantage plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage as original Medicare does. But many plans also offer additional benefits like dental, hearing, and vision coverage as well as gym/fitness memberships, and most plans also include prescription drug coverage.
Medicare Advantage plans are also less expensive than if you had the original Medicare plus a separate Part D drug plan and Medigap policy. Many Advantage plans have $0 or low monthly premiums and don’t always have a deductible, but they also usually have a high spending maximum. In 2021, Advantage plan participants were on average responsible for a maximum of about $5,100 for in-network care and about $9,200 when out-of-network care is included.
How to choose
To help you choose a plan, a good first step is to call the chiefs of staff of the doctors you use and find out which Advantage plans they accept and which they recommend. Then go to the Medicare Plan Finder tool at Medicare.gov/plan-compare to compare Advantage plans in your area. This tool provides a five-star rating system that rates each plan based on past customer satisfaction and the quality of care provided by the plan. When comparing, here are some key points to consider:
Total costs: Look at all plan prices, not just premiums and deductibles. Compare maximum out-of-pocket costs plus co-payments and coinsurance billed for doctor visits, hospital stays, specialist visits, prescription drugs and other medical services. This is important because if you choose an Advantage plan, you are not eligible to purchase a Medigap policy, which means you will be responsible for paying these expenses out of pocket.
Drug coverage: Check the plan formulary – the list of covered prescription drugs – to make sure all the drugs you take are covered without excessive co-pays or having to try cheaper drugs first.
Dental, vision and hearing benefits: Many Advantage plans include dental, vision and hearing benefits, but they are usually limited. Get the details on what exactly is covered.
Coverage outside your home: Most Advantage plans limit you to using in-network doctors only in a service area or geographic region, so find out what’s covered if you need medical care when you’re away your house.
Out-of-network coverage: Check what’s covered if you want to see a specialist at a hospital that’s not part of a plan’s network. You can get a list of doctors and hospitals that participate in a plan on the plan’s website.
If you need help choosing a plan, contact your state health insurance assistance program at ShipHelp.org or call 877-839-2675. Also check out the 2022 HealthMetrix Research Cost Comparison Report on MedicareNewsWatch.com which lists the best Advantage plans by health condition.
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Send your senior questions to: Savvy Senior, PO Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is an NBC Today contributor and author of “The Savvy Senior.”