Savvy Senior

How to Choose a Medicare Advantage Plan

Dear Savvy Senior,

I’ll be 65 in a few months – Medicare enrollment age – and am interested in getting a Medicare Advantage plan to cover my health care and prescription drugs. Can you give me some advice on choosing a plan?

Searching Senior

Dear Searching,

Medicare Advantage plans have become increasingly popular among retirees over the past few years. In fact, around one-fourth of all Medicare recipients – nearly 13 million Americans – are currently enrolled in a Medicare Advantage plan. Here are some tips and tools to help you choose the best plan for you.

Medicare Advantage

Sometimes called Medicare Part C, Medicare Advantage plans are government approved health plans sold by private insurance companies that you can choose in place of original Medicare. The vast majority of Advantage plans are managed-care policies such as HMOs or PPOs that require you to get your care within a network of providers.

If you join an Advantage plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage – some plans even offer extra benefits like vision, dental and hearing. And, most plans include Part D prescription drug coverage too.

You also need to be aware that the monthly premiums for many Advantage plans are cheaper than if you got original Medicare, plus a separate Part D drug plan and a Medigap policy, but their deductibles and co-pays are usually higher. That makes these plans better suited for healthier retirees.

How to Choose

To help you choose a plan, a good first step is to call your doctors and find out which Advantage plans they accept, and which ones they recommend. Then go to the Medicare Plan Finder tool at http://www.medicare.gov/find-a-plan and compare those options. When comparing, here are some key points to consider:

Total costs: Look at the plan’s entire pricing package, not just the premiums and deductibles. Compare the out-of-pocket maximums plus the copays and coinsurance charged for doctor office visits, hospital stays, diagnostic tests, visits to specialists, prescription drugs and other medical services. This is very important because if you choose an Advantage plan, you’re not allowed to purchase a Medigap supplement policy, which means you’ll be responsible for paying these expenses out of your own pocket.

Drug coverage: Check the plan’s formulary – the list of prescription drugs covered – to be sure all the medications you take are covered without excessive co-pays or requirements that you try less expensive drugs first.

Extra benefits: Many Advantage plans include dental, vision and hearing benefits, but they are often limited. Get the details on what exactly is covered.

Out-of-network coverage: Since most Advantage plans limit you to using in-network doctors only, find out what’s covered if you have an emergency outside your network area. This is especially important if you travel extensively or live part of the year outside your network.

Locations: If you don’t use any particular doctors and you live in a rural area, make sure the doctors in the plans you’re considering are located near you. Also check to see if the hospitals, home health agencies and skilled nursing facilities that the plan covers are nearby too.

Retiree benefits: If you have coverage from a former employer, be sure you speak with the benefits manager, because signing up for Medicare Advantage may void your retiree coverage.

Get Help

If you don’t have a computer to compare plans, or if you don’t feel comfortable working through this information on you own, you can get help by calling Medicare at 800-633-4227. They can do the comparing for you over the phone, and enroll you in a plan when you’re ready.

Another good resource is your State Health Insurance Assistance Program, which provides free Medicare counseling. Visit shiptalk.org, or call 800-677-1116 to locate a counselor in your area. And, check out the HealthMetrix Research "Cost Share Report" at medicarenewswatch.com. This service chooses the best Advantage plans based on health status.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of "The Savvy Senior" book.