7 Things To Consider Before Enrolling In A Medicare Advantage Plan


7 Things To Consider Before Enrolling In A Medicare Advantage Plan

Medicare is a healthcare program that is provided by the government for elderly citizens over 65 years old. This service is also for younger people provided they have disabilities. In order to be qualified for Medicare, you must be a US citizen or have been living in the country for over 5 years.  When American citizens turn 65, they receive social security benefits and are automatically enrolled in Medicare Part A and Part B. Part A and Part B cover hospital costs and doctor visits respectively. If you take prescription drugs and need to be covered you need to enroll in Medicare Part D which isn’t done automatically. There is also Medicare Part C or Medicare Advantage plan which will give you the same advantages as Part A, Part B, and Part D but it is only provided by insurance companies. Medicare Advantage plans may seem tempting but before you enroll, there are a few things that you should consider first.

1. The Costs

The first thing that you should consider before you enroll in a Medicare Advantage plan is the costs. You should learn about the costs of premiums, the deductibles, and the prices of different services like hospitals and doctors’ visits. You should also know that there is an annual limit in these plans for the amount of money that you pay out of your pocket. Once this limit is reached, you won’t have to pay anything for all the services that are covered by the plan for the remainder of the year.

2. The Coverage

As mentioned before, the Medicare Advantage plans will provide you with the same coverage as Part A and Part B. The coverage provided by these plans includes prescription drugs, dental care, vision care, and hearing care. You will have to pay a monthly sum of money for the plan that you choose. If you don’t want to pay extra money out of your pocket, you should avoid medical facilities that aren’t covered by your plan. 

3. Service Providers

There are different types of Medicare Advantage plans and some of them have their own limitations. For example, if you pick one of the popular plans like the HMO plan, you will discover that you will be limited by the service providers that you can use. Additionally, if you choose a service that isn’t covered by your plan, you will have to pay high fees. Like anything in life, these plans have their pros and cons so you shouldn’t make a choice before you do some thorough research first. You should know that in some cases, people end up paying more money than the Original Medicare. For instance, if you want to be provided with more service providers, you can opt for other types of plans but it will cost you.

4. State Coverage

Unlike the Original Medicare which provides the same kind of coverage in all states, Medicare Advantage plans only provide certain coverage in some areas or states. This can be a huge disadvantage because if you have to move to another state or area, you may need to change plans since your current plan may not be available.

5. CMS Ratings

Before choosing a Medicare Advantage plan, you should first check its rating on the Centers for Medicare & Medicaid Services or CMS. These centers do annual evaluations for the quality and performance provided by these plans across the country. They are usually rated from one to five stars. You should opt for a 5 stars plan to guarantee that it will provide you with the highest quality of care and coverage.

6. Your Doctor and Prescribed Drugs

You should make sure that your prescribed drugs are covered by the plan that you are going to choose. If you have a preferred pharmacy, make sure that it is also a part of your coverage. Additionally, since there are always changes in networks, you should check to see if your doctors and preferred hospital are all covered by your plan as well. 

7. Additional Benefits

All Medicare plans have different additional benefits. So before you make a decision, make sure that the plan you choose will be beneficial to your needs and lifestyle. It is recommended to check all plans’ additional benefits and compare them to one another until you can settle on the right one for you.

Your health should be your number one priority, and you should spend your golden years knowing that you will be taken care of. The Medicare Advantage plan isn’t perfect, it has its advantages and disadvantages. Since we are talking about your health and well-being here, this is a decision that you shouldn’t make lightly. Research and understand all plans first before you decide if one of them is right for you or if you want to stick to the Original Medicare.

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