If you’re shopping around for a Medicare Advantage plan this year, you may be wondering what the best plan is for you. This will depend on your personal situation, medical needs, how much you can afford, and other factors.
There are tools available to help you find Medicare Advantage plans in your area that can meet all your healthcare needs.
This article will explore how to determine the best Medicare Advantage plan for your situation, as well as tips for how to enroll in Medicare.
With all the changes being made to the Medicare plans on the market, it can be hard to narrow down the best plan for you. Here are a few things to look for in a Medicare Advantage plan:
- costs that fit your budget and needs
- a list of in-network providers that includes any doctor(s) that you would like to keep
- coverage for services and medications that you know you’ll need
- CMS star rating (details in the next section)
Read on to learn what else you might consider when shopping for Medicare Advantage plans in your area.
The Centers for Medicare & Medicaid Services (CMS) have implemented a Five-Star Rating System to measure the quality of health and drug services provided by Medicare Part C (Advantage) and Part D (prescription drug) plans. Every year, the CMS releases these star ratings and additional data to the public.
Medicare Advantage and Part D plans are measured by a variety of factors, including:
- availability of health screenings, tests, and vaccines
- management of chronic health conditions
- member experience with the health plan
- plan performance and member complaints
- customer service availability and experience
- drug pricing, safety, and accuracy
Each Medicare Part C and D plan is given a rating for each of these categories, a single individual star rating for Part C and D, and an overall plan rating.
The CMS ratings can be a great place to start when shopping around for the best Medicare Advantage plan in your state. Consider researching these plans for more information on what coverage is included and how much it costs.
To see all available Medicare Part C and D 2019 star ratings, visit CMS.gov and download the 2019 Part C and D Medicare Star Ratings Data.
When you choose a Medicare Advantage plan, you first want to consider what type of coverage you need in addition to the coverage above.
Most Medicare Advantage plans offer one, if not all, of these additional types of coverage:
- prescription drug coverage
- dental coverage, including yearly exams and procedures
- vision coverage, including yearly exams and vision devices
- hearing coverage, including exams and hearing devices
- fitness memberships
- medical transportation
- additional healthcare perks
Finding the best Medicare Advantage plan means making a checklist of the services you want to receive coverage for. You can then take your coverage checklist to the Find a Medicare 2020 Plan tool and compare plans that cover what you need.
If you find a plan that looks good for you, don’t be afraid to call the company to ask if they offer any additional coverage or perks.
In addition to identifying what you want in a healthcare plan, it’s also important to determine what you need for your long-term healthcare needs.
If you have a chronic condition or travel often, these things can play a role in the type of plan you’ll need. Different plans offer different benefits depending on your own personalized situation.
Within the CMS rating system, you can find which plans are rated highly for a variety of chronic health conditions. Plans are rated on their quality of care for osteoporosis, diabetes, high blood sugar, high blood pressure, kidney disease, rheumatoid arthritis, bladder conditions, and older adult care (falling, medication, chronic pain).
The type of Medicare Advantage plan you have is also important. There are five types of plan structures you want to consider when looking for a plan:
- Health Maintenance Organization (HMO) plans. These plans are primarily focused around in-network healthcare services.
- Preferred Provider Organization (PPO) plans. These plans charge different rates depending on whether the services are in network or out of network. (A “network” is a group of providers who contract to provide services for the specific insurance company and plan.) These may provide more options to receive out-of-network care.
- Private Fee-for-Service (PFFS) plans. These plans let you receive care from any Medicare approved provider who will accept the approved fee from your plan.
- Special Needs Plans (SNP). These plans offer additional help for medical costs associated with specific chronic health conditions.
- Medicare Medical Savings Account (MSA) plans. These plans combine a health plan that has a high deductible with a medical savings account.
Each plan offers options to accommodate your healthcare needs. If you have chronic health conditions, SNPs are designed to help alleviate some long-term costs. On the other hand, a PFFS or MSA plan might be beneficial if you travel and need to see out-of-network providers.
One of the most important things to consider when choosing the best Medicare Advantage plan is how much it will cost you. The Find a Medicare Plan tool lists the following cost information with the plans:
- monthly premium
- Part B premium
- in-network yearly deductible
- drug deductible
- in- and out-of-network out-of-pocket max
- copays and coinsurance
These costs can range from $0 to $1,500 and above, depending on your home state, the plan type, and the plan benefits.
To get a starting estimate of your yearly costs, consider the premium, deductible, and out-of-pocket max. Any deductible listed is the amount that you’ll owe out-of-pocket before your insurance begins to pay out. Any out-of-pocket max listed is the maximum amount that you will pay for the services throughout the year.
When estimating your Advantage plan costs, consider these costs plus how often you will need to refill prescription drugs or make office visits.
If you require specialist or out-of-network visits, include those potential costs into your estimate as well. Don’t forget to consider that your amount may be lower if you receive any financial assistance from the state.
If you already receive other types of healthcare benefits, this may factor into what kind of Medicare Advantage plan you’ll need.
For example, if you already receive original Medicare and have opted to add Part D or Medigap, many of your needs may already be covered.
However, you can always do a coverage comparison to determine if a Medicare Advantage plan would work better or be more cost-efficient for you.
tips for applying for medicare
The Medicare enrollment process can begin as early as 3 months before you or your loved one turns 65 years of age. This is the best time to apply, as it will ensure that you receive coverage by your 65th birthday.
You can wait to apply for Medicare until the month of your 65th birthday or the 3 months following your birthday. However, coverage can be delayed if you wait, so try to apply early.
Here is some important applicant information you will need to have on hand to apply for Medicare:
- place and date of birth
- Medicaid number
- current health insurance
Once you have the necessary information listed above, head over to the Social Security’s website to apply. Once you or your loved one’s Medicare application is processed and accepted, you can begin shopping around for a Medicare Advantage plan to suit your needs.
One important thing to note is that if you’re already enrolled in Medicare parts A and B but aren’t enrolled in Part C, Part D, or some other prescription drug coverage, you could face a late enrollment penalty.
This penalty kicks in if you’re not enrolled within 63 days of your initial enrollment period. This enrollment is usually your 65th birthday, but it may be earlier if you’re on disability or meet other criteria.
If you receive the late penalty, it will be applied to your Part D monthly premium permanently.
If you’re having a hard time finding a Part C plan, don’t wait to purchase Part D coverage, or you risk having the permanent Plan D penalty.
There are many factors that can influence which Medicare Advantage plan you choose. Consider the CMS star rating, your priorities and healthcare needs, how much you can afford, and what type of insurance you currently have.
It’s important to enroll in Medicare before you turn 65 to ensure that you don’t go without medical coverage. Don’t forget that you have the power to shop around for the best Medicare Advantage plan that fits all your needs.