If you’re looking for a Medicare Advantage plan this year, you might be curious about which plan is best. Your situation, medical requirements, budget, and other factors will determine your best plan.
Medicare Advantage plans typically offer additional benefits beyond what Original Medicare covers, such as vision, hearing, and dental services. Choosing the right Medicare Advantage plan is essential because it can affect your personal expenses, access to healthcare providers, and coverage for prescription drugs.
In this article, we will provide tips on choosing which Medicare Advantage Plan is best for you.
Types of Medicare Advantage Plans
When you start looking for a Medicare Advantage plan, it’s important to understand the differences between each plan type.
There are five types of Medicare Advantage plans, each with its own rules and restrictions:
Health Maintenance Organization (HMO)
You will likely need to choose a primary care physician for your HMO plan who will be responsible for coordinating your care. Before seeing a specialist, you’ll also need a reference from your primary care doctor.
HMO plans typically provide lower personal expenses than other Medicare Advantage plans, but for non-emergency treatment, you must remain in the plan’s network. (A “network” is a group of service providers under contract to carry out tasks for the particular insurer and plan.)
Preferred Provider Organization (PPO)
These plans normally permit you to see medical professionals not in the plan’s network, but you will typically pay more for such care. With a PPO plan, you can see a specialist without a referral, but you might still be required to cover a copayment or coinsurance for each visit.
Private Fee-for-Service (PFFS)
PFFS plans, the insurance company decides how much it will pay for each healthcare service you receive. Any Medicare-approved healthcare provider who accepts the agreed-upon payment from your plan may provide you with care under these programs.
You don’t need a referral to see a specialist, but not all healthcare providers accept PFFS plans. If you see a provider who doesn’t accept the plan’s payment terms, you may need to pay more out of pocket.
Special Needs Plans (SNP)
Insurance companies design SNP plans for individuals with chronic health conditions like diabetes, heart disease, or certain healthcare needs. These plans typically have a provider network tailored to the needs of people with a specific health condition, and they may offer extra benefits like disease management programs.
Medical Savings Account (MSA)
These plans combine medical savings accounts with a high-deductible health plan. You can use the money in the savings account to pay for healthcare expenses, and the insurance company pays for covered healthcare services after you’ve reached your deductible. MSA plans generally have lower monthly premiums than other Medicare Advantage plans, but you’ll need to pay for all healthcare services until you reach your deductible.
Every plan provides options to satisfy your healthcare requirements. If you have ongoing medical issues, SNPs can help you save money in the long run. On the other hand, a PFFS or MSA plan might be useful if you travel and need out-of-network treatment.
Factors to Consider When Choosing a Medicare Advantage Plan
Choosing the right Medicare Advantage plan is essential to meet your healthcare needs and budget. To help you make an informed decision, consider the following factors:
Premiums
Medicare Advantage plans may have monthly premiums in addition to the Medicare Part B premium. Some plans may have low or no premiums, while others may have higher premiums.
Deductibles
Some plans may have deductibles, which you must pay out of pocket before the plan begins covering your healthcare expenses. Consider the deductible amount and the maximum out-of-pocket amount, the highest sum you will pay for services throughout the year.
Copayments and Coinsurance
Copayments and coinsurance are the amounts you’ll need to pay out of pocket for each healthcare service you receive. Some plans may have lower copayments or coinsurance for certain services, while others may have higher costs.
Prescription Drug Coverage
Medicare Advantage plans with prescription drug coverage may have different formularies and copayments for different medications.
Provider Network
Ensure your preferred healthcare providers are in the plan’s network and consider whether you must pay more for out-of-network care. Make a list of the doctors you want to continue seeing who are in-network providers.
Extra Benefits
Some Medicare Advantage plans may offer extra benefits beyond what Original Medicare covers, such as vision, dental, or hearing services.
By comparing these factors, you can choose a Medicare Advantage plan that meets your healthcare needs and fits your budget. Reviewing the plan’s Summary of Benefits and Coverage is important to understand its costs, benefits, and rules.
Check out the video below for the difference between Original Medicare and Medicare Advantage Plan.
Wesley Evans
Choosing The Right Medicare Advantage Plan for You
Choosing the right Medicare Advantage plan is a necessary step for your healthcare needs and budget.
Resources are available to help you choose a Medicare Advantage plan on Medicare.gov and State Health Insurance Assistance Programs (SHIPs). If you live in Southern CA, you can use my Medicare Advantage Plan Finder tool to help you find the perfect plan for you.
Or if you prefer more one on one assistance, you can schedule a call.
