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Choosing the right Medicare health plan is one of the most important decisions you can make. But, sorting through all the different plans can be confusing. We're here to help!
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A Medicare Advantage plan takes the place of your Original Medicare plan. Instead of being run by the government, Medicare Advantage plans are offered by private companies. These plans may be Health Maintenance Organziations (HMOs), Preferred Provider Organizations (PPOs) or Private-Fee-For-Service (PFFS).
Basically, HMO plans will offer less expensive premiums and more restricted networks of doctors and hospitals while PPO and PFFS plans will offer wider networks but more expensive premiums.
View the 2011-12 Medicare Plan Ratings.
What You Should Know
- If you choose a Medicare Advantage plan, you must drop your Medicare coverage and enroll with the private insurance company that is offering the plan. You must enroll during "open enrollment," which happens once a year from January 1 to March 31. You can also enroll when you first become eligible for Medicare. (Three months before you turn 65, the month of your birthday, and three months after.)
- Medicare Advantage plans may be a better choice for the type of health you need. But, the cheapest plan is not always the best plan. Make sure you compare not only the actual monthly premium, but the following:
- co-payments (the set amount you pay at each visit to your HMO doctor)
- percentages (the percentage you pay at each visit to your PPO or PFFS doctor)
- deductible (the amount you pay to your Advantage plan before your benefits "kick in")
- hospital coverage (can vary greatly from plan to plan)
- prescription drug benefits (is your prescription covered this year?)
- annual limit on your out-of-pocket expenses (this is important; there should be a limit)
- Make sure your doctor is in the Advantage plan's network. If you must go out of network, what is the cost?
- Does the Advantage plan cover vision, hearing and dental care? What about fitness or health club memberships?
- It is not necessary to enroll in a Medicare Advantage plan just to get prescription drug coverage. You also have prescription drug benefits available through your Original Medicare (Medicare Part D).
- Are you geographically undesirable? You may not have a wide choice of plans in your area. Also, if you live in different states throughout the year (Florida for the summer?), then a Medicare Advantage plan is not the best choice.
Medicare Advantage Plan Types
- Medicare Advantage Fact Sheet - KFF.org
- Medicare Advantage Wikipedia Page
- Master Theses from University of North Texas: "Comparison of Medicare Advantage Plans & Original Medicare for Home Health Services"