Medicare Advantage plans combine Parts A and B of traditional Medicare coverage for eligible individuals. Also known as Medicare Part C, Medicare Advantage plans often include benefits that are not available with traditional Medicare, such as dental, vision and prescription drug coverage.
These benefits vary among different plans. The best way to determine the right plan for a specific person is through a Medicare Advantage plan comparison:
PPOs, HMOs and Special Needs Plans
Medicare Advantage (Part C) plans are administered by private insurance companies that have been approved by Medicare and are administered within specified plan networks. Part C Medicare plans offer a combination of Parts A (hospital insurance) and Part B (medical insurance). Many Part C plans also include prescription drug coverage, also known as Part D, which is not included in traditional Medicare plans. Some Medicare Advantage plans also offer additional services, such as dental, vision and hearing care, and sometimes even health and wellness programs that encourage senior fitness.
When comparing plans, one of the first considerations is the type of Medicare Advantage plan. There are three major categories of Part C plans: Preferred Provider Organizations (PPO), Health Maintenance Organizations (HMO), and Special Needs Plans.
Members enrolled in Preferred Provider Organization (PPO) plans can use any doctor or medical care facility they wish, but receive deep discounts when consulting with medical providers within the network. Members enrolled in Health Maintenance Organizations (HMO) customarily pay lower premiums, but must use medical care providers within the network to obtain coverage — and must often obtain referrals for specialists within the network.
Special Needs Plans provide low-cost coverage for specific conditions of people who are enrolled, such as end state renal failure (ESRD) or chronic heart failure (CHF). People enrolled may consult with medical care providers outside the network, but at greatly increased costs.
Compare Costs and Benefits
When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B based on the month of your 65th birthday. Afterward, special enrollment periods exist for people who didn't sign up when they were first eligible, and for current Medicare members to change to a different Medicare Advantage plan or revert to traditional Medicare.
When comparing plans, it’s a good idea to take advantage of open enrollment or unenrollment periods — even for members who are happy with their present coverage. Insurance companies regularly make changes to network providers, drug coverage and other important aspects of a plan. Likewise, members’ needs may change; for instance, they may develop a chronic health condition or need new prescriptions.
Steps in Selecting a Medicare Advantage Plan
Choosing a Medicare Advantage plan may seem like a daunting task. Breaking the process up into smaller steps make it less of a chore, and is the best way to ensure that the plan selected provides needed coverage at the most affordable price possible.
The first step is to determine which Part C plans are available from approved insurance companies, such as Anthem. The second step is to conduct a Medicare Advantage Plan comparison of costs — including copays, deductibles and coinsurance and benefits for services that will be used most.
After that, there are three vital considerations: choosing between an HMO and a PPO, determining whether preferred doctors are including in a plan’s network, and ensuring that prescribed medications are covered.
Making the Final Selection
Choosing the right Medicare Advantage plan involves comparing the features of different Medicare Part C plans with one another while considering whether those features provide needed coverage. It’s a smart strategy to take advantage of open enrollment and unenrollment periods to determine if changes in coverage needs or benefits merit a change in Medicare Advantage plans. By considering factors such as whether the plan offers PPO, HMO or Special Needs coverage along with specifics such as inclusion of preferred doctors or required prescriptions, prospective Part C subscribers can ensure that the plans they choose provide the coverage they need at a price that works within their budgets.