Medicare Part C (Medicare Advantage) provides coverage in place of Original Medicare. If you’re considering Medicare Advantage, it can be hard to know which is the right plan for you. It’s best to have a coverage checklist — before you enroll — to make sure the plan will meet your medical needs. Today, The Fussell Group Insurance Advisors explains what to look for in an Advantage program.
Consider the Costs, Coverage, and Limitations
When looking for a Medicare Advantage plan, it’s important to think about the costs, benefits, and restrictions that may apply. Some Advantage plans have a $0 premium but know that these aren’t free. There are other costs you’ll need to deal with when you join a program.
Consider the following:
- Coverage area
- Doctor networks
- Summary of benefits
- Ratings and reviews
- Copays and coinsurances
Related Post: How Do Medicare Advantage Plans Work?
Why You Should Consider the Coverage Area
You’ll want to consider the service area because Medicare Advantage plans aren’t portable.
Some programs have networks that require members to see doctors in their county. If you rarely travel, this isn’t a big issue. But if you travel frequently, you may consider a Medigap plan instead. Think about how often you’ll be traveling in retirement and whether you’ll need to get care while you’re away.
Check the Network of Providers
Doctor networks should be first on your checklist. With certain plans like HMOs or PPOs, you’ll pay out-of-pocket if you see a provider outside the network. You’ll also need a referral often — from your primary doctor — to visit a specialist.
Make sure your preferred doctors are within the network of the plan you choose. Then you’ll avoid out-of-pocket expenses.
Note: Find out if your Part D coverage works at your local pharmacies. Or see if the plan offers out-of-network coverage.
What Are the Copays and Coinsurance?
Copayments or “copays” are dollar amounts. Coinsurance is a percentage. Before you join a plan, it’s important to understand these amounts and know the limit on what you’ll pay out-of-pocket. The cost of every service varies by plan. In the end, go with the plan that best suits you and your lifestyle.
Related Post: What Are Medicare Advantage Special Needs Plans?
Summary of Benefits
Another key item on your checklist is the plan’s Summary of Benefits, a simple review of the Evidence of Coverage (EOC). Plan members get this annual report from their company every September, which details the costs and coverage, among other things. Your insurance agent will talk about the details with you from this benefits summary — before enrolling in the plan of your choice. That way, you’ll know it offers the coverage you need!
Advantage Plan Ratings and Reviews
While researching plans, you may also benefit from reading online reviews. Hearing about other people’s experiences can give you a good idea of what to expect and, potentially, what plans to avoid. You’ll catch a glimpse of how the coverage works.
If you see multiple complaints about limited doctor networks, the need for prior authorization, or stories of high out-of-pocket costs, you’ll probably want to keep away from the plan in doubt.
Choose a Medicare Advantage Plan
Now that you know what to look for in a Medicare Advantage plan, it’s time to get the right coverage for you. The Fussell Group Insurance Advisors can help you find the best program in your area — making sure it meets your needs without draining your wallet. Call 1-877- 874-0711 to speak with a Medicare professional.