How to Select a Medicare Advantage Plan in Your Area

If you’re among the 17.8% of the United States population who are covered by Medicare, you may decide to receive your Medicare benefits through a Medicare Advantage plan. Medicare Advantage, also called Medicare Part C, allows you to obtain your Original Medicare benefits (Part A and Part B) and additional benefits through a Medicare-approved private insurance company. Although this is beneficial, how do you select a suitable Medicare Advantage plan in your area from the many options available to you? Here’s what you need to know.

Searching for Medicare Advantage Plans Offered in Your Area

The private insurance companies that offer Medicare Advantage plans are approved by Medicare to offer benefits to Medicare recipients. Each plan offers its own network of credentialed healthcare providers and varying additional benefits in the specific regions and states where they are licensed to sell insurance plans to consumers. With that in mind, you should first check to ensure that your desired Medicare Advantage plan is offered in your region of residence. Contacting a licensed Medicare insurance agent will give you insights and comparisons on Medicare Advantage plans available in your area.

Comparing Medicare Advantage Plans

Since there are limited opportunities for plan adjustments during each calendar year, you want to evaluate and compare various plans before you enroll in one. Here are the factors that you should consider when making your choice.

In-Network Providers – You should select the Medicare Advantage plan that includes healthcare providers that are located conveniently near you. These providers include hospitals, pharmacies, and doctors. You should confirm that your providers, such as doctors and any specialists you currently see, are listed as being within your chosen network, or that suitable alternative doctors are within that network. This is important because Medicare Advantage plans may not pay or will pay a very small percentage of the medical expenses you incur when you use a provider that’s out of network.

Star Rating – Medicare has a quality rating system that evaluates each of the plans. The rating is based on the customer satisfaction and quality of services that a Medicare Advantage plan offers. The star rating scale runs from one to five stars, with a five-star rating being the highest quality score. Star ratings should not be used as a stand-alone decision-making factor, rather as yet another resource available to help beneficiaries make their enrollment decisions.

Prescription Coverage – Most, but not all Medicare Advantage plans include prescription drug coverage, so first be sure your possible selections include this benefit (unless you already have other creditable prescription drug benefits). Then, identify the plans that have your prescription drugs under its list of covered medications, often called a formulary. Check the tiers, deductibles, coinsurance and copayment costs of these plans. You should evaluate different plans’ prescription drug coverage terms, so you have a strong understanding of the cost for you to get your prescription medications.

Out-Of-Pocket Limits – Unlike Original Medicare, Medicare Advantage plans offer an out-of-pocket limit, which is the maximum amount of money you would have to pay from your pocket for medical expenses in one year. The limit should be within your budget estimate. If you feel that you cannot afford it, you should perhaps consider a plan with higher monthly premiums, but with a lower out-of-pocket limit. Please note however, that the out-of-pocket limit does not include your prescription drug costs.

Monthly Premiums – Medicare Advantage plans have varying monthly premiums, with the national average for Part C plans hovering around $23 and plans can have premiums as low as $0. Consider that you’ll still have to pay other expenses such as coinsurance, deductibles and copayments. Ideally, you should go for a plan that has fair premiums when compared to the medical benefits that you will enjoy.

Medical Benefits – Most Medicare Advantage plans include additional benefits such as coverage for vision, dental and hearing care. Additional benefits may include transportation, health wellness programs, gym memberships and a 24-hour nurse line. Select the Medicare Advantage plan that offers you the highest level of value in terms of meeting your medical and financial needs.

After weighing all these factors, you should be able to select a suitable Medicare Advantage plan in your area. Your selection should be guided by your health needs, the convenience of accessing care from network providers and your budget. For assistance evaluating the Medicare Advantage plans you’re interested in, contact a local Medicare insurance agent today. Our team at Medicare Portal includes highly experienced Medicare insurance agents available for consultations in-person, over the phone and via video conferences – contact us today!


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