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How to choose a Medicare Advantage plan

How to Choose a Medicare Advantage Plan

If you’ve decided that you want to enroll in a Medicare Advantage plan, you may have quickly discovered that choosing a plan is a daunting task. Depending on where you live, you may have just a few options, or you may have close to a hundred. How do you know which insurance company and which plan to choose?

We’re going to help you answer that question today.

Step 1: Find an Independent Broker

I’ve you’ve read our other articles, seen us on YouTube, or heard us on our podcast, you probably know how much we stress working with an independent insurance broker for your Medicare coverage. Even if you don’t use us at Giardini Medicare, we really want you to get customized help from a knowledgeable agent. This can save you tons of time, tons of money, and a headache or ten.

Independent agents contract with many insurance carriers, so they’ll be able to compare plans, benefits, and rates on your behalf. You won’t have to spend hours on the phone talking to different companies and then try to compare the plans yourself. Plus, independent agents (versus captive ones) have absolutely no loyalty to any one carrier. Our job is to make sure our clients get the coverage they need and want. YOU are our only loyalty!

If you’d like to begin your own research on the Medicare Advantage plans available in your area, you can navigate to and use their “plan finder” tool. This will give you a list of all the MA plans in your area.

Step 2: Prioritize Coverage Details

This step will take the most effort, and you’ll need to make some important decisions about the kind of coverage you want. There are five things to consider.

Type of Plan

Not all Medicare Advantage plans work the same way. There are several kinds of MA plans, but the most common are HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans.

HMO plans typically offer lower out-of-pocket costs. The “catch” is that they also have more rules. You’ll need to choose a primary care physician (PCP), who will then coordinate all the care you receive. In some HMO plans, you’ll be required to obtain a referral from your PCP before seeing a specialist. In addition, they don’t offer any coverage outside of the HMO network. If you see a non-contracted provider, you’ll be responsible for the entire cost of services (except in emergencies).

PPO plans might have higher out-of-pocket costs, but they give you greater flexibility. You don’t have to choose a PCP or get referrals if you’d like to visit a specialist provider. They also give you the freedom to receive care from a non-contracted provider - you’ll just pay higher cost-sharing amounts.

Provider Networks

Regardless of the kind of Medicare Advantage plan you have, staying within that plan’s network is going to be beneficial. Consider your current doctors and the facilities you prefer. Are they all within that plan’s network? If they’re not, are you willing to switch providers or locations?

Your independent broker will be able to tell you who participates in the plans. But, if you’re checking their status yourself, be sure to ask if they contract with Medicare Advantage. A provider may choose to contract with a company’s under 65 or employer plans, but they may not contract with the same company’s MA plan.

How often do you travel? If you spend a lot of time away from home, you’ll want a plan that offers regional or national coverage. Many plans now offer “national reciprocity,” which means that you can see contracted providers in any state. Other plans restrict access to your specific service area.

Prescription Coverage

Many Medicare Advantage plans include prescription drug coverage. If you’re taking prescriptions, make sure the plan offers coverage for those prescriptions. Remember, these plans bundle lots of different benefits, so the entire plan needs to fit your needs - not just the medical portion.

Out-of-Pocket Costs

We can’t always predict the healthcare services we’ll need, but if you know what services you’ll need now or in the future, you should review the costs associated with those things. Ask yourself these questions:

  • Do you have any upcoming surgeries?
  • Do you need physical therapy?
  • Are you concerned with hospitalization costs?
  • How likely are you to reach the plan’s maximum out-of-pocket?
  • Do you see a chiropractor or use other alternative treatments not typically covered by Medicare?

Decide what coverage you’re most likely to use, and then check the plan’s cost-sharing amounts for those services.

Extra Benefits

The extra benefits you’ll get in a Medicare Advantage plan are probably the reason these plans have become increasingly popular in the last few years. You will not find coverage for these extras in Original Medicare or a Medigap plan. Every plan is different, but here are a few common things you’ll find in most MA Plans.

  • Routine dental/vision/hearing services
  • Gym memberships
  • OTC or grocery stipends

Don’t let these extra benefits be the reason you choose a specific Medicare Advantage plan. But, if there are some you’d really enjoy having in your plan, let your agent know so they can take it into consideration when searching for plans that fit your needs.

Step 3: Narrow Your Choices

It’s time to narrow down the plans! Start by running an analysis of the prescription costs. This step alone should narrow down your choices to a handful of plans. Don’t forget to make sure you know which pharmacies are preferred with each plan. Using a preferred pharmacy will give you the least out-of-pocket costs for prescriptions.

Next, check the provider networks. If you’re not willing to change providers, determine with carriers your providers are contracted with. If they don’t participate with any carrier, you’ll want to choose a PPO plan.

Now, compare premiums and out-of-pocket medical costs for the procedures that are most important to you. You should also compare the plan’s maximum out-of-pocket (MOOP), especially if you’re someone who knows they’ll be using the plan frequently

Lastly, consider the extra benefits. Which ones are most important? Dental care is often high on the priority list. Do you need hearing aids? Glasses?

Step 4: Enroll

Your independent advisor will submit your application for you. Yes, you can enroll directly with the insurance company, but you won’t have the customer support you will with an independent agent. Plus, there are no fees to use their services, so you may as well have access to their extra support and service!

Step 5: Review Your Plan Annually

All the hard work is done! But, there’s one more important thing to know.

Medicare Advantage plans are annual contracts that run from January 1 to December 31. They can (and usually do) change every year. Your plan might change its premium, deductible, cost-sharing amounts, extra benefits, networks, etc. Because of that, you’ll want to review your plan every year during AEP, the Annual Enrollment Period.

The annual review won’t take long. You’ve already decided what’s important to you, and you’ve had time to use your current plan. Did it work well for you? Were there things you didn’t like? Review that with your agent, and then take a new look at the plans in your area. Maybe you’ll keep the same one, or maybe you’ll find a plan you like even more. It never hurts to look!

To learn more about Medicare Advantage, call us at Giardini Medicare. We’ll answer your questions and take the time to get to know you and what’s important to you. When you’re ready to compare plans, we’ll show you options and help you make decisions. Call us today and speak with one of our licensed agents.


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