Finding the Right Medicare Advantage Plan: 5 Must-Know Considerations

Medicare Advantage is undeniably popular as its enrollment figures and plan options are rising. In 2023, more than 51 percent of eligible Medicare beneficiaries joined Medicare Advantage (MA) plans, also known as Medicare Part C.

One compelling factor driving seniors and people with disabilities to get their Medicare benefits through MA plans is their cost-saving abilities. Compared to the Original Medicare, the premiums and overall costs associated with Medicare Advantage tend to be lower. On average, MA spending is approximately 7 percent lower than the  Original Medicare.

Private insurers approved by Medicare offer these MA plans. Medicare pays them to cover your Medicare benefits if you decide to enroll in an MA plan. Most plans offer additional benefits that Original Medicare doesn’t cover. But MA plans also come in various types with different coverage and cost-sharing requirements.

There’s no one-size-fits-all scenario when choosing a Medicare Advantage plan. This article examines six considerations to help you find the right plan.

Budget and Plan Costs

Regarding costs, the MA plan’s premium or the maximum amount you must pay out of pocket each month are two primary factors you must consider.

For 2023, the maximum out-of-pocket limit for MA plans can be $8,300 or less for in-network services. It can go up to $12,450 for combined in-network and out-of-network care. When choosing the plan, ensure you can afford the maximum limit amount.

Moreover, the projected average premium for Medicare Advantage stands at $18 per month in 2023. However, the actual amount you pay can vary, depending on the plan types, copays, drug coverage, and extra benefits. Other costs you can anticipate for your coverage include deductibles and copayments.

You can shop Medicare Advantage quotes to get a starting estimate of your annual costs. Doing so will help you compare all the plans in your area and find the one that fits your budget and needs.

Coverage Priorities

All MA plans include the same coverage as the Original Medicare, such as hospital coverage (Part A) and medical coverage (Part B).

When deciding on your MA plan, you may want to consider what type of coverage you should prioritize in addition to the hospital and medical coverage. For instance, if you have maintenance medications, you want an MA plan offering additional coverage for prescription drugs.

You should also factor in long-term healthcare needs when selecting your MA plan. Doing so will help you ensure that you obtain comprehensive coverage and support you in the long term. Your primary care physician may be able to assist you in making more informed decisions about the health care services you need in the future.

CMS Star Ratings

The Centers for Medicare and Medicaid Services (CMS) uses a five-star quality rating system to evaluate how well Medical Advantage plans perform. The CMS publishes these ratings and other data annually, making them accessible to the public.

These ratings can be an excellent place to begin your search when shopping around for an MA plan in your state. You can easily compare plans’ overall quality, performance, and member satisfaction by looking at the overall or summary ratings. The best plans get a 5-star rating.

However, it’s essential to note that the plan’s star rating is only one factor you must consider. A plan with a high start doesn’t necessarily mean the right choice for you. Always factor in the plan’s cost, coverage, and network for providers.

Access To Providers

Some MA plans, like Health Maintenance Organizations (HMOs), restrict your choice of healthcare providers. This means you may not be able to see specialists who are not affiliated with the plan unless you have a referral from your primary care provider. But it may come with a small copayment for the visit.

When choosing an MA plan, it’s also vital to cross-reference your healthcare providers to ensure they’re part of your insurance plan’s network. As much as possible, you would want to minimize out-of-pocket costs when seeking the services of your regular healthcare providers.

Available Assistance Programs

Although Medicare can help cover medical and health-related costs, it’s not entirely free. However, some programs can help you pay for your Medicare costs. So, when choosing a Medicare Advantage plan, you may want to look into whether there’s an accessible assistance program to alleviate out-of-pocket expenses.

It’s worth noting, however, that eligibility for these programs ultimately depends on limited income and assets. Various free online tools can connect you with certain benefits you may qualify for. You can also get valuable information and assistance from experienced insurance brokers and state-area offices to determine eligibility.

Carefully Assess Your Options Before Enrolling

Numerous factors go into deciding what MA plan is appropriate for you. Some considerations may be unique to your specific needs and preferences. Regardless, take the time to research and carefully assess your options before enrolling.

Contact the carrier directly if you plan to enroll or switch to a different plan. This way, you can verify that all details match what you see online. Remember that you have the power to explore different options and find the MA plan that aligns with what you need and prefer.

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