If you choose to get your Medicare coverage from a Medicare Advantage plan, it is important to compare your options and pick the right plan for your specific needs and preferences. Plans vary significantly and may change from year to year, making it important to compare options carefully and review your coverage annually.
Understand how Medicare Advantage compares to Original Medicare.
As the traditional health insurance program offered by the federal government, Original Medicare is accepted by most doctors nationwide. Most doctors in the country take this insurance.
Medicare Advantage plans work with the federal government to provide Medicare benefits. They must offer at least the same coverage as Original Medicare, but they can have different rules, costs, and restrictions.
For example, you usually have to use in-network doctors for the lowest costs. Depending on the plan, you may need a referral to see a specialist or obtain prior authorization for certain services. In many cases, prescription drug coverage is also included as part of a Medicare Advantage plan. You may pay a monthly premium for this coverage in addition to your Medicare Part B premium. Many plans also cover some things that Original Medicare cannot. Medicare refers to these as supplemental benefits. Common examples include dental and vision coverage or a gym membership.
If Medicare Advantage is the right option for you, find a plan that meets your needs.
Ask questions about providers, like: Are my doctors in the plan’s network? Which hospitals and nursing facilities by me are in the plan’s network? If they are not in network, will the plan still cover me but at a higher cost? Do I need to get a referral from my primary care provider to see specialists?
Ask questions about costs, like: How much are the plan’s premium, deductible, and copays? What is the plan’s maximum out-of-pocket cost? How much will I pay if I see an out-of-network provider? How do these costs compare to Original Medicare?
Ask questions about prescriptions, like: Does the plan cover my medications? Are there coverage restrictions on those medications? How much will those drugs cost? Is my pharmacy in network?
Ask questions about supplemental benefits, like: Does the plan offer additional benefits not covered by Original Medicare? Are these extra benefits optional or mandatory? What are the costs associated with this benefit? Are there any restrictions or rules I need to follow for this coverage? Would these benefits support my ability to live independently at home and improve my health and wellbeing?
Use Medicare’s Plan Finder to compare plans and enroll.
You can use Medicare Plan Finder on Medicare.gov to compare Medicare Advantage and stand-alone Part D plans available in your ZIP code. Plan Finder provides information about costs such as premiums and deductibles, drugs included on the plan’s formulary, and the star rating of the plan.
To use Plan Finder, you will need to go to Medicare.gov and click on the button that says, “Find Plans Now.” You can do a general search by continuing without logging in. If you wish to save your results and information, you can log in using your Medicare account.
Before enrolling, it’s a good idea to call the plan directly to confirm any information you see on Plan Finder. Plan details can change, and Medicare may not immediately update all information in Plan Finder. You should also contact your health care providers to confirm that they accept the plan.Enroll through Plan Finder, call 1-800-MEDICARE, or contact the plan directly.
Watch out for misleading marketing.
Health insurance companies try to reach people in various ways, like television commercials, radio ads, events, mailings, phone calls, and texts. Medicare has rules for companies selling private plans (Medicare Advantage or Part D plans). These rules help protect Medicare beneficiaries from aggressive or misleading marketing practices.
Before you enroll in a plan, make sure you understand its benefits and rules. Contact the plan you are considering or your local State Health Insurance Assistance Program (SHIP) to confirm if the plan will cover services you need and make sure that you get everything in writing.
Remember that an agent or broker should never pressure or mislead you into joining a plan. They should also never offer gifts to sign up or say they were sent by Medicare or Social Security. If an agent pressures or misleads you, save any related information, such as an agent’s business card, messages, marketing handouts, or other contact details.
You should report this to your local Senior Medicare Patrol (SMP) or SHIP. Your SMP or SHIP can help you review the concern and report it to CMS as a potential marketing violation.
Still have questions?
Your SHIP is here for you! You can contact your SHIP for any Medicare-related questions or concerns you have. The federal government funds SHIP counselors to help people understand their Medicare options and make informed coverage decisions at no cost to them. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
If you think you have experienced potential Medicare fraud, errors, or abuse contact your local Senior Medicare Patrol using the online SMP Locator or by calling 877-808-2468.