5 Questions To Ask When Choosing A Medicare Advantage Plan

Medicare Advantage plans, or Medicare Part C, are health care plans offered by Medicare-approved private companies.

Determining which plan is right for you is important to your health and wellness — choosing the wrong plan could cost you more than necessary, but too little coverage can leave you unprotected. To get assistance in choosing a suitable plan, contact a licensed insurance agent at MedicareAdvantage.com. As one of the nation’s largest Medicare sellers, will walk you through side-by-side plan comparisons to determine the right choice for your needs and help answer questions along the way.

If you are interested in exploring your Medicare Coverage options, here are five questions to ask when choosing a Medicare Advantage plan.

Learn more and visit MedicareAdvantage.com or call 1-844-919-3456 today to find out if you’re eligible to enroll and to compare plan benefits and costs where you live.

1. Am I Eligible For A Medicare Advantage Plan?

Before you choose a Medicare Advantage plan, you will need to determine whether you qualify. To be eligible, you must meet two requirements.

• Be enrolled in Original Medicare.
• Reside in an area where Medicare Advantage plan insurance providers serve and are accepting new applicants.

With these qualifications in mind, applicants should know that having a Medicare Supplement insurance plan will disqualify them from obtaining a Medicare Advantage plan at the same time.

2. What Medicare Advantage Plans Are Available?

With several Medicare Advantage plans available, knowing which one best suits your needs can help you make an informed decision. Here’s what you should know about each plan:

• Health Maintenance Organization (HMO) Plans. HMO plans will only cover in-network medical providers and hospitals, generally based on county lines or zip codes, except in emergencies or for urgent care. They require you to choose a primary care physician and obtain referrals before specialist visits.
• Preferred Provider Organization (PPO) Plans. PPO plans provide more flexibility by offering in-network provider options and out-of-network provider access for a higher charge. You are not required to choose a primary care provider and referrals aren’t usually necessary for specialists.
• Private Fee-for-Service (PFFS) Plans. PFFS plans allow for more freedom of choice when it comes to choosing providers, as beneficiaries can visit any Medicare-approved provider who accepts the plan’s payment terms for treatment. In emergency situations, you will still receive treatment regardless of whether the provider accepts the terms.
• Special Needs Plans (SNPs). Those with specific diseases or health or financial conditions can benefit from SNP plans, which are limited to those with disabling or chronic conditions, including dementia and HIV/AIDS, as well as those in care facilities. Beneficiaries must choose a primary care physician and obtain referrals for specialist visits. Aside from emergencies, beneficiaries must visit in-network providers to receive coverage.
• Medical Savings Accounts (MSAs). With MSAs, beneficiaries obtain a high-deductible plan with a bank account that can be accessed to cover all required Medicare services.

If you’re unsure of which plan you qualify for, a licensed insurance agent from MedicareAdvantage.com can help you discuss your options.

3. How Much Will My Medicare Advantage Plan Cost?

According to Medicare.gov, not all Medicare Advantage plans charge a premium. However, for plans that do require premium payments, beneficiaries are likely to pay around $17.60 per month — the average premium cost in 2023.¹

Ultimately, these costs will vary depending on carrier, benefits provided, location and more. To get a better picture of what costs you can expect to pay, review MedicareAdvantage.com’s guide on the average cost of Medicare.

4. How Will a Medicare Advantage Plan Impact My Existing Coverage?

To help ensure a plan seamless coverage, you’ll want to understand how a Medicare Advantage plan will impact your existing coverage. According to Medicare.gov, any eligible person can join a Medicare Advantage plan, including those with pre-existing conditions. However, beneficiaries may only obtain coverage from one Medicare Advantage plan at a time.²

To make sure you don't lose your insurance, check with your benefits administrator to see if you can sign up for a Medicare Advantage plan. If you enroll in a way that goes against the rules, you could lose your union or employer coverage permanently, and that includes coverage for your dependents, too.

5. When Can I Enroll In A Medicare Advantage Plan?

In most cases, Medicare Advantage applicants can only enroll in a new plan during designated enrollment periods. That’s why it’s important to carefully time out your application to ensure you maintain health care coverage.

Applicants have the option to enroll in a plan multiple times: during their Initial Enrollment Period (IEP), the fall Annual Enrollment period and during a Special Enrollment Period (SEP). An IEP is offered to those who are newly eligible for Medicare, beginning three months prior to the applicant’s 65th birthday and lasting for seven months total.

Those whose IEP has ended can apply during the Annual Enrollment Period, which spans from October 15 to December 7 annually and allows beneficiaries to sign up for, disenroll or change their coverage.

Applicants going through a qualifying life event, such as relocating to a region not served by their current provider, transitioning in or out of a nursing home or getting discharged from prison, can apply for an SEP at any time regardless of whether enrollment is open.

Find The Right Plan With MedicareAdvantage.com

Getting the right health coverage is crucial to receiving proper care; however, it might be intimidating to navigate the process if you’re unfamiliar. That’s where MedicareAdvantage.com comes in. It offers various resources and services, including side-by-side plan comparisons, interactive quizzes and assistance from licensed insurance agents, to help you determine what plan is best for you.

Looking to make the most of your Medicare journey? Visit MedicareAdvantage.com today or call 1-844-919-3456 to speak with an experienced licensed insurance agent who’s ready to help.

¹https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
² https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options

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TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage HMO, PPO and PFFS organizations that have a Medicare contract. Enrollment depends on the plan’s contract renewal.

Not all plans offer all of these benefits. Availability of benefits and plans varies by carrier and location. Deductibles, copays, coinsurance, limitations, and exclusions may apply.

Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a Special Enrollment Period.