The Medicare Advantage aka “Medicare Part C” option creates fierce competition among private insurance companies, so much so that laws have been enacted to limit the aggressiveness of their marketing efforts.
My Aunt Virginia found it positively overwhelming—the number of booklets, brochures, and other mailers that flooded her mailbox as she approached her 65th birthday.
Insurance company agents...
- Are not allowed to contact you by phone until after you’ve signed up for a Medicare Advantage plan.
- Agents are not permitted to try to steer you into a specific plan.
- They may not offer you any additional products beyond the Part C coverage that you specifically sign up for.
Even so, most insurance agents still have a financial incentive to sign you up for their company’s Medicare Advantage “Part C” plan.
Medicare Advantage plans are for those who require an expanded level of coverage beyond what comes standard with Medicare Parts A (hospital care) and B (medical care).
Medicare Advantage plans may offer vision or dental coverage. They may also lower your out-of-pocket limits, thereby reducing your overall health care costs.
Listed below are five other key considerations that may factor in to your choice of an appropriate Medicare Advantage plan.
Remember, you may find that your best option is retaining the standard Medicare Parts A and B benefit package.
1. Consider the Prescription Drug Factor
Medicare Part B doesn’t directly cover the costs of prescription drugs.
Most Medicare Part B recipients will enroll in Part D (prescription drug) coverage and will pay, on average, $34.10 per month for this coverage.
The majority of Medicare Advantage plans have prescription drug coverage built in.
To aid in your decision-making process, be sure to compare the combined premium expense of Parts A and B plus Part D against the total premium expense of a Part C plan.
You should also use the Medicare plan finder at Medicare.gov to find the expenses associated with the specific drugs you need.
2. Make an Intelligent Forecast of Your Healthcare Needs
As you age, your medical care becomes more frequent and therefore more expensive.
When choosing a Medicare Advantage plan, consider how often you’re likely to visit the doctor or require other forms of care on a yearly basis. Average care patterns of Medicare recipients are listed in the figure below.
3. Consider a Medicare Advantage Plan as an Alternative to Medigap
If you’re not familiar with “Medigap,” it refers to a privately offered Medicare supplement insurance that limits out-of-pocket expenses, deductibles, and coinsurance payments but increases your monthly premium payments.
Before investing in a Medigap plan, you should inspect Part C plans.
Many Part C plans will serve the same function as Medigap. Out-of-pocket expenses for Part C plans are legally required to remain below $6,700 per year. In 2016, a quarter of all Part C plans had an out-of-pocket maximum of $3,400 or less.
4. Investigate Employer-Based or Union-Based Coverage
For persons still covered by an employer-based or union-based health care plan, a Medicare Advantage plan may create an unnecessary increase in premiums. This could be in the form of redundant coverage and it may result in the unwanted cancellation of your employer- or union-based plan.
Check with your company’s HR department or your union’s benefits administrator for Medicare advice.
5. Make Sure You Have Adequate Flexibility in Health Care Providers
Most Medicare Advantage plans are PPOs or HMOs. HMOs are often limited to what’s called a “home network.”
Home networks can cause trouble for those who travel frequently, because they limit in-network coverage to local providers. HMOs may also restrict access to specialists, requiring that you first obtain a referral from your primary care doctor.
PPOs, by contrast, allow you to go directly to a specialist.
Original Medicare (Part A plus Part B) also allows you to go directly to a specialist.
Remember, if you have a Medicare Advantage plan, you will still pay your basic Medicare premium in addition to your Medicare Advantage premium.
The doctors who take Medicare Advantage plans are usually the same doctors who take standard Medicare. The main value of Medicare Advantage plans is the potential for better prescription drug options and better out-of-pocket/premium configurations.
Bryan is a the Senior Finance Contributor for ClydeBank Media. He specializes in the worlds of tech and finance, having both authored and collaborated with industry veterans on a variety of titles. Listen for his voice when searching for investment strategy and financial wellness tips. Bryan’s newest investing course is available now on the ClydeBank Media Campus.