How to choose a Medicare Advantage Plan

Broeren - How to Choose a Medicare Advantage Plan_shutterstock_71160727_web

This year’s Medicare Annual Election Period kicks off on October 15. What does that mean? Everyone eligible for Medicare has from October 15 until December 7 to continue with their current coverage or change to a new plan.

In our 16-county service area, Medicare Advantage plans are the most popular, with 45 percent of people choosing that type of plan. So, how do you select the right Medicare Advantage plan? I’ll answer a few questions to help you shop for the right Medicare Advantage plan.

What is the maximum out of pocket (MOOP)?

Like other types of insurance, we buy health insurance to protect us from financial hardship when costly and unexpected events occur. How do you make sure that you limit your risk with a Medicare Advantage plan? You look at the maximum out of pocket. This is the total amount you will pay yearly for your health care under the plan, not including your prescriptions at the pharmacy. As you will see, this can range from $3,000 to $10,000. Be sure you consider this first as it allows you to budget and provides protection no matter what occurs. 

What is the Medicare Advantage plan’s Star Rating?

Medicare rates all plans on a Star-Rating system. The rating ranges from a one-star plan to a five-star plan. A five-star rating is considered excellent. The overall plan rating makes it easy for you to compare plans based on quality and performance.

What types of Medicare Advantage plans are available?

HMO – Health Maintenance Organization

  • Usually need a referral to see a doctor
  • Must use in-network providers (doctors the health plan contracts with)

PPO – Preferred Provider Organization

  • Freedom to choose any provider but will pay more when going out of network (doctors the health plan doesn’t contract with)

PFFS – Private Fee for Service

  • The plan determines how much it will pay doctors, other health care providers and hospital, and how much you must pay when you get care

Are my Prescriptions covered?

Some plans DO NOT include coverage for your drugs. This is one of the most important things you need to understand. If you don’t have any other coverage for your medications, you should choose a plan with “Part D” prescription coverage, even if you don’t have a large number of medicines that you are taking. If you have other coverage for prescriptions, it is important that you understand what your choices are for the rest of your Medicare coverage. For example, if you have Wisconsin Senior Care or drug coverage from Veterans Affairs (VA), you can likely just choose a plan that is called a “MA only” Medicare Advantage plan. However, if you have a drug plan from an employer as part of your retirement benefits, you may be limited in what you can choose to combine coverage.

Finally, after I purchase my coverage what customer service support will I get?

Everyone promises great customer service, but here are some things to consider:

  • When I call, do I get a person or do I have to push many buttons before I get to speak with someone?
  • Do I have my own customer service person or do I have to re-tell my story every time I call?
  • Can I understand the person I am calling, is he/she local and does he/she understand what I need?
  • Do they reach out to make me aware of issues or things I should know of?
  • If I should become ill, are there nurses and social workers available to help me and my family?

If you are new to this, there are many more things to consider, and a good health plan offers the support and education to make good decisions that are right for you. I am proud to say that the Medicare team at Network Health does just that.

Leave a Reply