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Comparing Medicare Advantage Plans

Published November 7, 2022

With so many Medicare Advantage plans available in almost every location throughout the country, choosing a single plan that’s best suited for your situation can be difficult and overwhelming. The best way to compare Medicare Advantage plans is to focus on these four factors:

  • Plan Benefit Review
  • Network
  • Prescriptions
  • Additional Benefits

Plan Benefit Review

All Medicare Advantage plans are annually renewed, and benefits and premiums can change every single year. All plans are effective from January 1st through December 31st. While it may seem cumbersome, Medicare Advantage Plans are interested in increasing memberships in every location. As a result, Medicare Advantage Plans are competing on every detail including:

  • Premiums
  • Deductibles
  • Co-pays
  • Co-insurances
  • Out-of-pocket maximums

This has notably improved the benefits available within Medicare Advantage plans.

Compare the Networks

Minimizing costs can be summarized in one word: network. One of the ways to reduce overall costs is to use in-network healthcare providers when you require healthcare services. Every Medicare Advantage plan will have different cost-sharing responsibilities — including deductibles, co-insurance, and out-of-pocket maximums — which will vary depending upon whether or not you are using an in- or out-of-network provider. Networks can change every year, and in some instances, there can be changes within a calendar year; a factor that you cannot control. For example, if you have an HMO, then you could be responsible for all the costs if you go to an out-of-network provider unless it is an emergency.

Compare Prescription Drug Coverages

The majority of Medicare Advantage plans include prescription drug benefits, but some do not, which might fit those that have prescription drug benefits from other payers (for example, the Veterans Administration). The overall cost of prescriptions can vary depending on the plan that you choose. Some tips for looking at lowering your prescription drug costs:

  • See if the plan you are looking at has a deductible. Many plans that have a deductible may only have it for certain tiers of drugs such as brand drugs.
  • Some plans offer lower copays or coinsurance for using a preferred pharmacy.
  • Many plans also offer a mail-order option that could lower your costs.

In addition, it is important to shop around and make sure your pharmacy is in your plan’s network.

Compare Additional Benefits

These receive a lot of attention because of the fact these additional or “extra” benefits are not covered under Medicare Parts A and B alone. Dental, vision, hearing benefits, health club memberships, and more are constantly evolving. A lot more plans are offering comprehensive dental. We are seeing plans have a flex debit card to pay for certain benefits instead of having to submit for reimbursement. Also, plans are starting to offer specific benefits to those with specific chronic conditions such as heart or diabetic conditions. Some benefits include the value-add of purchasing healthy food.

Look Into the Different Types of Medicare Advantage Plans

There are many different categories of plans, so it’s important to keep in mind that while these plans may look similar, and the terminology may look similar to what you’re familiar with from your individually purchased or employer-sponsored plan, the precise way Medicare Advantage plans work can be subtly different from individual or employer-sponsored health insurance prior to becoming Medicare-eligible.

HMO (Health Maintenance Organization)

Under an HMO, you're required to designate a primary care physician (PCP) and that physician may need to provide a referral in order for you to receive further healthcare services. If you do not use in-network providers, then you can expect to be responsible for 100% of the cost of receiving healthcare services unless it is an emergency. Before receiving further services, you can check to make sure that the healthcare provider is in-network.

HMO-POS

Under HMO-POS, it’s possible to receive some healthcare services from out-of-network healthcare providers. This highlights the fact that Medicare HMOs can differ from HMOs that you encounter in pre-Medicare, individual health insurance, and employer-sponsored markets.

It is possible that the primary care physician can refer you to out-of-network providers, which will allow you to see a combination of in- and out-of-network providers. Healthcare services can be expected to be more expensive if a lab or specialist is out of network. In addition to that, the annual out-of-pocket maximum limit is, in most cases, higher if you use a combination of in- and out-of-network providers.

PPO (Preferred Provider Organization)

Under a PPO, no referral is required. Any healthcare provider that accepts federal Medicare will accept a PPO, but you may be charged the out-of-network cost, which may include higher deductibles, copays, coinsurance, and annual out-of-pocket maximum.

This can be valuable if you frequently require services outside your local area, if you travel, or if you have a health situation that you know requires services from a variety of healthcare providers.

OpenMedicare Can Help You Find a Medicare Advantage Plan

On average, there are almost 40 Medicare Advantage plans available per zip code, which can make selecting a plan challenging, to say the least. For further assistance, you can reach out to a licensed partner by calling us at (844) 910-2061, or find the right Medicare plan by visiting our website.


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