Choosing a Medicare Advantage Plan

Over the past decade, the number of older Americans enrolled in a Medicare Advantage (MA) plan has soared from 6.8 million in 2006 to 17.6 million in 2016. In fact, Medicare Advantage plans, which are administered by private health insurers rather than by the federal government, now account for about one-third of all Medicare recipients.

It’s not surprising that these plans are growing in popularity. MA plans are required by law to give the same benefits as standard Medicare, and most also include added benefits above what standard Medicare provides.

Many people pay nothing for their MA plans beyond their usual Medicare B premium. Every MA plan also includes a maximum annual out-of-pocket cost per recipient, providing a certainty that ordinary Medicare can’t match. Medicare recipients can switch to another Medicare plan if desired during Medicare’s annual open enrollment period (from October 15 through December 7). People who have Medicaid as well as Medicare can join a Medicare Advantage plan at any time, and those who are newly eligible for Medicare have a seven-month window to enroll. With so many benefits, it’s easy to see why more and more people are choosing the MA option.

Are You Eligible for Medicare Advantage?

If you’re interested in exploring the Medicare Advantage option, the first step is to determine your eligibility.

  1. Age. Virtually everyone over age 65 who qualifies for coverage under Medicare Parts A and B is eligible for Medicare Advantage, unless they have end-stage renal disease (meaning they require regular dialysis treatments).
  2. Residency. The next step is to check whether you live in an area where Medicare Advantage plans are available. Most Americans live in areas where multiple MA plans are available. In fact, the average Medicare recipient can choose from as many as 19 different MA plans.

Next, check to see whether your primary care doctor participates in any Medicare Advantage plans. Most primary care physicians are part of one or more MA networks. If your doctor isn’t, you might have to change primary care physicians if you want to join MA (which most people are understandably reluctant to do).

Finding a MA Plan That’s Right for You

If you are eligible for a Medicare Advantage plan and your doctor participates (or you are willing to switch), then the next step is to carefully review the benefits and cost of the Medicare Advantage plans available in your home area.

It’s a good idea to reach out to the individual companies to learn all the details about their offerings. Many individual insurers offer a variety of Medicare Advantage plans, with costs and benefits that may vary somewhat. Most plans have representatives available by phone or online to walk you through their offerings.

One question to ask is whether the plan requires a referral from your primary care physician before you can see a specialist. You should also check to make sure the plan’s network of providers includes any specialists you see, as well as your preferred pharmacy.

With a range of enhanced benefits, a cap on annual out-of-pocket costs, and the care coordination and health planning services of an experienced insurance provider, the appeal of Medicare Advantage is clear. If you’re a Medicare recipient, take a few minutes to explore the MA plans in your area.

Find out about VNSNY CHOICE Health Plans.