Focus: Wellness - Medicare Advantage Plans

Tools, tips and tricks to help you choose your healthcare coverage in retirement

Photo by National Cancer Institute on Unsplash

We went into some detail on Medicare options in this post last month. Today I want to talk about Medicare Advantage plans. You will choose between traditional Medicare and a Medicare Advantage plan when you enroll. You can’t have both. Having said that, you can switch back and forth under certain circumstances, including each year during the open enrollment period, if you do not like your choice, so don’t sweat it too much.

What’s the difference between Medicare and Medicare Advantage?

I like the way AARP talks about the difference between Medicare and Medicare Advantage. They say it’s like choosing a prix fixe menu (Medicare Advantage) or a buffet (traditional Medicare). When you sign up for Medicare Part A, you can opt in for Part B, Part D and Medigap or use other insurance that you have elsewhere (from your employer, for example or independent dental and vision). When you choose an Advantage Plan, you get what they give you. It will be similar to the PPO or HMO you are used to.

What are the advantages to Medicare?

Advantages to Medicare include being able to go to almost any physician you currently use. You would not have to find one in the network of the Advantage Plan that you chose. Most doctors currently take Medicare. (Be aware, though, that if you are looking for a physician, about 1/3 of the physicians in the country are not taking NEW Medicare patients.) You also would be able to access care anywhere in the country without worrying about whether the providers were in network or out of network. Most Advantage plans are regional, so that could be a consideration if you travel a lot or if you have a second home or a vacation home somewhere else in the country.

What are the advantages to Medicare Advantage policies?

Advantages to Advantage plans include easier logistics (you only have to keep track of one policy, not 4) and often more coverage. Every plan is different, but most cover prescription drugs and many cover things like dental and vision that Medicare does not cover. More and more these plans are also covering preventive care, like gym memberships and home improvements like wheelchair ramps.

With a Medicare Advantage plan, you must still pay the government-set annual Part B premium and sometimes an additional premium for the Advantage plan, but instead of paying the 20 percent coinsurance amount for doctor visits and other Part B services that you would pay with Medicare, most Advantage plans have set copay amounts for a physician visit, and typically that means lower out-of-pocket costs than traditional Medicare. Advantage plans also have an annual cap on out-of-pocket expenses.

How do I choose between Advantage policies?

OK, if you do decide to go with Medicare Advantage, how do you decide WHICH Advantage plan is right for you? Every single one of them is different and every single person that contacts you, or brochure that you get will tell you why their plan is best. How do you compare? Well… it ain’t easy. But it’s not impossible, either. You just have to take a little time to sort through it all, OR you could take advantage of your State Health Insurance Assistance Program (SHIP). These resources will give you personal, one-on-one help from (mostly) volunteers who have had training in Medicare and Medicare-related issues. You can Google SHIP and find the resource for your state. You can also call the Medicare Assistance Help Line (1-800-663-4227). But, if you want to DIY, there are tools for that, too.

Medicare has a tool that will help you compare Advantage plans. The problem with it is that it is the same tool that helps you compare Part D plans, so it’s mostly focused on the prescription medication portion of the plans. The best way to bypass this “feature” is to tell it you don’t want any prescriptions. You can then narrow down your list of choices based on the other aspects of the policy. Once you have a “short list” you can go back and compare prescription drug coverage between those to find the one that’s best for you. Go to the Plan Finder put in your zip code, tell it you don’t want drug coverage and VOILA up pops all of the available plans for your area. You’ll have a lot of different numbers and options to look at. First, eliminate any that are non-starters, like if you absolutely have to have vision coverage or a certain doctor or quality rating. Once you whittle it down by taking out the showstoppers, you might want to put together a matrix like this one to look at all of the plans side by side. (If you want this one, just reply to this newsletter and I’ll send it to you.)

From the comparison list, choose the few that look the best, based on your requirements. Now that you have a short list of possible options, go back to the Plan Finder and see which one has the best coverage for your prescriptions. From that, you’ll have a pretty good idea of what viable options you have and which may be best for you. Signing up is easy. Just take the phone call the next time the sales rep tries to contact you. :-) Or call them and you’ll be their best friend for life.

What if my choice sucks?

So, you did all of your homework. You compared plans. You chose the one that was right for you. And you HATE it! Now what? Well, you have a few options. 1) You can use the annual disenrollment period that runs from January 1 through February 14 of each year. 2) If you joined an Advantage plan when you turned 65 you can change your mind any time within the first 12 months of joining. 3) If this is your first time on an Advantage plan and you dropped a Medigap plan to join it, you have the right to return to traditional Medicare and be reinstated in your Medigap any time within the first 12 months of the Advantage plan. 4) If you move outside of your plan’s service area you can switch to another plan or to traditional Medicare within 63 days of the end of coverage. 5) If an Advantage plan in your area has earned Medicare’s top 5-star quality rating you can switch to that plan at any time and of course 6) you can switch any time during open enrollment. There are several other reasons you could move from one Advantage plan to another or switch to traditional Medicare, but they are more niche, so I won’t cover all of them here.

It’s that EASY!

And that’s it! I hope between last month’s post and this one, I answered your pressing questions about medical coverage after retirement. If I didn’t, please let me know in the comments or by replying to this newsletter!

Editor’s note: If it seems like these newsletters aren’t as consistent as they used to be, it’s because they aren’t. :-) I’m trying different days and times of the day for delivery and I’m trying longer and shorter formats with different numbers of links to see what people read and engage with. If you have a preference, by all means let me know! I want this newsletter to be engaging and easy to read for this community. Once I land on a day, time and format, I’ll let you all know what to expect in your inbox going forward!