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Health Insurance Basics

Easy Ways to Compare Medicare Advantage Plans

September 07, 2017

You've probably noticed there are a lot of Medicare Advantage (MA) plans out there to choose from. Depending upon where you live, you could have your choice of a dozen or more plans. Medicare Advantage (MA) plans are offered by a variety of private companies, and these MA plans are not all the same. How do you know which one might be best for you?

Things to Consider When Choosing a Medicare Advantage Plan

Let’s start by asking,  what is a Medicare Advantage plan? It's an alternative to Original Medicare run by a private insurance company instead of by the government. All MA plans, also known as Medicare Part C, must include hospital and medical coverage equal to Medicare Parts A and B. Beyond that, many MA plans have extras such as prescription drug coverage, wellness and fitness programs, and dental, vision and hearing benefits.

This extra coverage, along with its costs and particular rules, differs from plan-to-plan. So it's a good idea to compare the details of Medicare Advantage plans before you choose one.

Many people see a low Medicare Advantage monthly payment - as low as $0 - and assume that's all that matters. Don't be dazzled by that alone. You should examine how a plan's overall costs might add up over the year, including what you'll spend on:

  • Monthly payments
  • Deductibles
  • Copayments and/or coinsurance (your percentage of a service’s cost)
  • Out-of-pocket maximums, which may be different for in-network or out-of-network care

You might find an MA plan with a higher monthly payment is more affordable overall. Plus, cost is not the only factor to compare. Consider your own unique health situation and needs, along with the value of the extra benefits offered by those Medicare Advantage plans you’re considering.

Questions to Ask as You Compare Medicare Advantage Plans

Begin by checking out the Medicare Advantage plan benefits that go beyond Medicare Parts A and B:

  • Is prescription drug coverage included? If so, does it increase the monthly payment or require meeting a deductible before benefits begin?
  • Are the medications I take on the plan’s list of covered drugs?
  • Does the plan have restrictions, such as which pharmacies I can use or whether I need preapproval before I can get my prescriptions?
  • What kind of wellness programs or fitness options does the plan offer?
  • Does the plan cover eye exams, new glasses, hearing aids, and/or dental care?
  • What other benefits and services are included?
  • How much extra will I pay for any of these benefits?

Then look into the details of how you’ll get your covered services from doctors, hospitals and other providers with an MA plan:

  • Are my current or favorite doctors, specialists and hospitals all part of this plan?
  • Do I need to choose a Primary Care Physician (PCP)? If so, do I need their referral to see a specialist?
  • If I visit a doctor or facility that’s not in my plan, will I need to pay more — or all — of the costs?
  • What happens if I need services when I travel outside the area, or if I live in a different part of the country during part of the year?
  • Are there reputable skilled nursing facilities and home health services in the plan’s network if I need them?

Whether you’re considering Medicare Advantage vs. Medicare, or one MA plan vs. another, make sure you understand what each plan includes and what expenses you can expect. Some people like to consult a family doctor, insurance agent or trusted friend for a recommendation. But in the end, the choice is up to you.

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Empire BlueCross BlueShield is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Services provided by Empire HealthChoice Assurance, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

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