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How to Compare Medicare Advantage Plans

A Medicare Advantage Plan, also known as Medicare Part C, can help pay for costs not covered by original Medicare. Additionally, a Medicare Advantage Plan can provide many benefits that traditional Medicare doesn’t, such as coverage for prescription drugs, eyeglasses, hearing aids, and dental services. By selecting the right Medicare Advantage Plan for your personal healthcare needs, you’ll ensure you have appropriate coverage and affordable premiums.

Comparing Medicare Advantage Plan Types

When choosing a Medicare Advantage Plan, the three main criteria include the plan type, benefits, and costs. Medicare Advantage plans include HMOs, PPOs, and PFFSs. Rules regarding your provider network represent the main difference between plan types.

  • HMO (Health Maintenance Organization) – This Medicare Advantage Plan typically requires individuals to select a primary doctor or caregiver. Except for emergency care, policyholders are only covered when they visit health care providers within the HMO network.
  • PPO (Preferred Provider Organization Plan) – With this advantage plan, policyholders have more freedom when choosing a doctor or network provider. Individuals pay less when visiting a doctor within the preferred network. However, coinsurance and copayments may be higher for out-of-network providers.
  • PFFS (Private Fee-For-Service) – Policyholders have the flexibility to choose any doctor with this plan. However, not all healthcare providers will accept a PFFS plan.

Comparing Medicare Advantage Plan Benefits and Costs

Another consideration when choosing a Medicare Advantage Plan is the benefits. Medicare Advantage Plans pay for Medicare Part A and Part B Medicare costs and usually provide co-payments for services not included in original Medicare. Some of the most common Medicare Advantage Plan benefits to consider when selecting a plan include the following.

  • Out-of-Pocket Maximum– This is the amount of fixed out-of-pocket expenses policyholders will pay before insurance coverage takes over.
  • Annual Deductible– Most advantage plans have a $0 yearly deductible for those who choose doctors within the provider network.
  • Ambulance Services– Except for a one-time copay, most plans cover the costs of ambulance services.
  • Doctor Visits– Many plans cover the costs of visits to the doctor’s office.
  • Preventative Services– Most plans will cover all the costs of preventative services and screenings.

The final consideration when choosing a Medicare Advantage Plan is the costs. Some policies offer $0 premiums and often include Medicare Part D (prescription drug coverage). However, individuals are still responsible for paying Medicare Part B premiums, unless paid for by Medicaid or third-party coverage.

Medicare Advantage Plan Enrollment

Individuals may enroll in Medicare Advantage Plans during the initial enrollment (IEP) or annual enrollment periods (AEP). The IEP is when an individual first becomes eligible for Medicare, or during the first three months after their 65th birthday. The AEP takes place from October 15 until December 7.

To learn more about Medicare Advantage Plan Enrollment contact the professionals at (844) 374-1950. Our licensed insurance experts will be happy to answer any questions you have.