How to Choose a Medicare Advantage Plan
Choosing the right Medicare Advantage plan is an important decision. The plan you choose can have a big impact on your health and budget.
Enrolling in the right Medicare Advantage plan that fits your needs can be as easy as making an informed choice. Your first step is to understand what plans are available and which type of plan will best suit your health needs. Comparing the cost, benefits, and networks will help you choose the right healthcare plan.
Know your Medicare Options
You have four options when it comes to Medicare. Those options are:
- Original Medicare Only: Original Medicare is Part A (hospital insurance) and Part B (medical insurance).
- Original Medicare + a Part D Prescription Drug Plan: If you have Original Medicare and need coverage for prescription drugs, you may need to enroll in a Medicare Part D Prescription Drug Plan, often called a “standalone PDP.” That’s because Original Medicare doesn’t cover prescription drugs. Prescription drug plans are only offered by private insurance companies, so you will need to pay an additional monthly premium.
- Original Medicare + Medicare Supplement Insurance (Medigap) + a Prescription Drug Plan: Medicare Supplement Insurance, also known as “Medigap,” covers some or most of the costs that Original Medicare doesn’t pay. These plans are provided by private insurance companies and come with an additional monthly premium. Usually, the more coverage you want, the higher the monthly plan premium you’ll pay.
Medigap plans do not cover prescription drugs, dental, vision, hearing, wellness, or over-the-counter items. You would need to purchase additional plans to cover these.
- Medicare Advantage: Medicare Advantage (Part C) plans are offered through private companies, like Clover Health, which contract with Medicare and must have all the benefits of Original Medicare (Parts A and B).
With many Medicare Advantage plans, you get a health plan, prescription drug coverage, and additional benefits, like dental, vision, hearing, wellness, and more, all with $0 or low monthly premiums. Plus, Medicare Advantage plans usually have lower out-of-pocket expenses.
It’s one plan, one card, one premium, one company—easy!
Choosing a Medicare Advantage Plan
When choosing a Medicare Advantage (Part C) plan, there are a few things you need to think about.
- Cost - See if the plan has a premium and if the cost fits your budget. Also, look at the copays, coinsurance, and deductibles for the benefits that are covered.
- Network - Look at the plan’s network of doctors, specialists, hospitals, and pharmacies. Make sure the providers and locations you want to visit are in the network.
- Prescription Drugs - Look at the plan’s formulary to see if the medications you take are covered by the plan and, if so, how much it would cost you to fill a prescription.
- Extra Benefits Offered - Review all the benefits offered with the plan. Check out the extra benefits like dental, hearing, vision, OTC, gym memberships, and more. Those extras can help save you money and give you extra coverage to help you live healthier.
These are a few of the main items you should consider when choosing a Medicare Advantage plan. You should compare Medicare Advantage plans in your area to make sure you are getting the right plan for you and your needs.
You can view all Medicare plans available in your area by going to medicare.gov. On the Medicare website, you can type in your zip code and compare all the plans and benefits available.
Checklist for ensuring a plan is right
Ask yourself these questions to make sure a Medicare Advantage (Part C) plan is right for you:
- Will you have access to your favorite healthcare providers through the plan?
- Does the plan cover visits to out-of-network providers?
- Does the plan cover any specialists you may be seeing?
- Are your prescription drugs covered?
- Does the plan fit into your monthly budget?
- Will the plan help with healthcare costs and out-of-pocket expenses?
- Are there additional benefits or programs that are helpful to you?
How to take the next step / enroll
The next steps can be easy. Once you determine which plan you would like to enroll in, you can call or go to that insurance carrier’s website to enroll. You can also contact a licensed local sales agent who can help you sign up.
Most Medicare Advantage plans, like those offered by Clover Health, also offer local meetings where you can come and learn more about their plans and enroll at the event.
To view and sign up for a Clover Health Medicare Advantage Plan in New Jersey, Georgia, Texas, South Carolina and Pennsylvania, click here.
