Did you know that in 2022 over 3 million new people have signed up for health insurance under The Affordable Care Act? Well, if you are nearing the retirement age and haven’t considered getting health insurance yet, they’re missing out on many healthcare benefits. A program you must look close into with them is Medicare, specifically Medicare Advantage. However, we know that choosing a plan can be quite confusing for individuals who do not know what to look for.
Therefore, this post will talk about what a Medicare Advantage plan is and how to choose the right one based on medical needs and personal preferences. Several factors are involved in choosing the right Medicare coverage plan, and we’re here to help you address them.
An Overview of Medicare Advantage Plans
In simple words, Medicare Advantage Plans refer to plans that provide healthcare benefits from a private-sector insurer in the US under Medicare guidelines. Medicare Part C or Medicare Advantage Plans are alternative health insurance plans to Medicare Part A and B coverage (or Original Medicare Plans).
There are different Medicare Advantage Plans in the health insurance market. The wide range of plans can fit varying budgets, costs, personal needs, and patient preferences. The type of insurer one chooses will also have a great impact on one’s decision to sign up for Medicare Advantage per se since the costs and availability of Advantage plans can vary significantly.
How to Choose the Right Medicare Advantage Plan
Now that we’ve discussed what Medicare Advantage Plans are let us consider some of the main factors involved in choosing the right one. We would like to mention that a lot of changes have taken place in the Medicare plans marketplace. That’s why it is important to stay up to speed if you want to find the best possible plan. Here’re several factors involved in choosing the right Medicare Advantage Plan:
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- Medical needs and coverage requirements
- Potential healthcare costs (as a result of opting for Medicare coverage)
- CMS rating in a chosen area
- Existing healthcare benefits one either wants to keep or discard from one’s new plan
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Focus on Your Coverage Needs
For starters, a Medical Advantage Plan (Medicare Part C) will offer additional coverage, including the coverage that Original Medicare offers (Part A and Part B). In the process of choosing a plan, one must consider the type of coverage needed.
Below is a list of coverage options available under the Medicare Advantage Plan. Remember, the plans and offered coverage can change based on location, availability, private health insurers, and so on.
- Vision Coverage
- Dental Coverage
- Hearing Coverage
- Prescription Drug Coverage
- Medical Transportation
- Fitness Memberships
- Other Healthcare Benefits and Add-ons
The type and number of private-sector health insurers might be different in each city or even state. Therefore, it is important to make sure to check the list of available Medicare Advantage Plans in a chosen city. The list of coverage options above might not be the same for New York and Los Angeles for example.
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Calculate Potential Healthcare Costs (Compared them with Your Budget)
The next factor on our list is the estimate of the total healthcare costs you will have to bear as a result of opting for a Medicare Advantage Plan. It is important to learn how much it will cost before actually purchasing it and starting paying the premiums. In short, make sure it’s in your budget but also caters to their healthcare demands. Here’re a few important cost factors when assessing the overall expense of purchasing a Medicare Advantage Plan:
- Coinsurance and co-pays
- Yearly deductible (in-network)
- Monthly premium
- Drug deductible
- Part B premium
- Maximum out-of-pocket expense
One can experience a cost burden of around $0 to $1,500 or anywhere in between. It will depend on the type of Medicare Advantage Plan chosen, the add-ons included, location, and the overall requirements for the selected plan under Medicare.
For a near-accurate estimate of the annual healthcare costs, you should include deductibles, out-of-pocket expenses, and premiums in your calculations. Deductibles refer to the expenses that one will have to bear before the start of the insurance.
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Inquire About CMS Ratings
Centers for Medicare & Medicaid Services has introduced a 5-star rating system to rank different Medicare Advantage Plans (Medicare Part C) and Medicare Part D. The main consideration in the ranking system is the quality of drug and healthcare services delivered through each Medicare Advantage Plan.
The CMS has also taken up the responsibility of sharing additional public information related to Medicare Advantage Plans and star ratings. It is possible to shop for Medicare Advantage Plans using the CMS 5-star ranking system.
It will be much easier and more flexible to start with the best Medicare Advantage Plans and go through them to find a plan that works for you. You can learn about a variety of Medicare Advantage Plans on CMS.gov and shop for a plan on Hellahealth.
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Assess Any Existing Benefits You’re Entitled To
In case one is entitled to healthcare benefits before entering a plan, it is possible to factor into the new Medicare Advantage Plan. For instance, if you are receiving healthcare benefits from Original Medicare Plans, including Part A and Part B, those needs will already be in the coverage that the chosen Medicare Advantage Plan offers.
When is the Sign-Up Time for a Medicare Advantage Plan?
The annual enrollment period only starts on October 15 and ends on December 7. The coverage can delay if one is late, and the best approach is to apply for it early.
Since the eligibility requirements include the minimum age of the applicant to be 65, one can wait until their 65th birthday month to apply. The enrollment period for every individual begins 3 months before they turn 65 and 3 months after. So, the enrollment period lasts for a total of 7 months (including the birthday month).
Conclusion
You will have to consider a lot of factors before choosing the perfect Medicare Advantage Plan for them. You can start by assessing their needs and requirements as an applicant eligible for Medicare coverage. Then, you can start considering the monthly costs and annual healthcare costs that they’ll have to bear.
Finally, based on your location (Philadelphia), you can check the private-sector health insurers near you to learn about the availability of Medicare Advantage Plans.