Medicare Advantage Plans: 9 essential things to understand

It is necessary for every senior to avail the most appropriate Medicare plans to get good health coverage. But one should undertake proper and thorough research to ensure that the decision and selection is made.

Essential things to know to make the right selection

  • Identify plan regulations prior to enrollment: Since not every Advantage plan is said to work equally, the plan’s regulations are to be clearly identified. Rules of the plan are to be followed, such as getting referral for viewing the specialist or receiving prior approval for availing specific procedures, thus avoiding high costs. Out of network healthcare provider might not be covered in the plan or the costs could be much higher, which again depends upon the Advantage plan type taken.
  • Even if the person suffers from pre-existing disease, it is possible to enroll with Medicare Advantage Plans, unless he/she has End-Stage Renal Disease.
  • Enrollment, Switching or cancelling the plan is possible only during a specific time period. In majority of the cases, the person gets enrolled in the plan for about a year.
  • Some plans might pay fully or part of Part B premium.
  • In case, the person has limited income, then he/she can contact Medicaid (State Medical Assistance Office) to check if assistance is provided to pay Part B premium expenses or for the Part D premium along with other prescription drug costs.
  • While enrolling with any of the Medicare Advantage Plans, it is necessary to provide Medicare number along with start date of Part A &/or Part B coverage.
  • Part D (prescription drug) coverage is available through the plan. If the person avails a plan which includes prescription drug coverage and he joins Prescription Drug plan, then he/she is dis-enrolled automatically from the Advantage plan to be returned to traditional Medicare.
  • On selecting a plan, enrollment is possible by completing paper application, online application or by phone. The health insurance specialist or plan provider is to be contacted to identify how the selected plan can be enrolled with.
  • If there exists Union or Employer coverage, then it will be necessary to discuss with the Union benefits administrator or the employer to know about the rules prior to enrolling in Medicare Advantage Plans. Joining Advantage plans in few cases may cause the person to lose union or employer coverage. However, in other cases, the union or employer coverage can still be used in conjunction with the enrolled plan.

Click HERE to learn more about the benefits offered by Medicare Advantage Plans in 2018