Karen Purze is an author based in Chicago, IL. She writes about end-of-life planning and family caregiving at lifeinmotionguide.com.
Is Medicare Advantage right for you?
If you’ve watched any television at all in the past 18 months, there’s a good chance you’ve seen Pro Football Hall of Fame quarterback Joe Namath encouraging you to “make sure you’re not missing out” on Medicare benefits.
The ubiquitous commercials tout the benefits of Medicare Advantage in what some call misleading ads. Are these Medicare Advantage plans too good to be true? More importantly, is an MA plan (as they are sometimes called) right for you?
Medicare Advantage: a type of bundled Medicare health plan offered by private companies that contract with Medicare.
Nationwide, Medicare Advantage enrollment more than doubled over the past decade, with 2021 data showing 42% of Medicare beneficiaries enrolled in a Medicare Advantage plan (a 10% increase over 2020).
Medicare Advantage plans may offer supplemental benefits that Original Medicare doesn’t cover, such as home care, transportation, gym memberships, and vision, hearing, and dental services. In addition to added benefits, Medicare Advantage plans may feature lower premiums and a cap on your out-of-pocket expenses. However, your choice of healthcare providers may be more limited, as MA plans usually restrict coverage to participating providers in a limited geographic area.
It’s important to educate yourself to find the best options for your situation, says local expert Carrie Espinosa, principal adviser and owner of Horizon Benefit Services.
A plan might look good on paper but not be a good fit for you, she says. For instance, you may be interested in a specific Medicare Advantage HMO plan not knowing that if you’re out of state, you will only have emergency coverage. If you travel a lot or spend part of the year in another state, you may decide that particular Medicare Advantage plan may not be a good choice.
Robin Dawson, an independent insurance broker with Medicare Solutions Network, also emphasizes the need to evaluate your plan based on your lifestyle, needs, and budget. “Just because a friend or neighbor is spending less on their Medicare Advantage plan than you are on your insurance doesn’t mean you should change what you have.”
Ultimately, whether Medicare Advantage is right for you depends on a variety of factors. To choose a plan that meets your needs, consider which doctors are foundational to your care, how geographically portable the insurance needs to be, and how the plan benefits compare with other plans. Review your options every year because Medicare Advantage plan benefits can change annually.
In addition to the monthly cost, look at the copay amounts and the maximum out-of-pocket amounts. “Consumers looking at Medicare Advantage plans need to look beyond the monthly fixed cost for insurance and consider all copays and coinsurance costs related to the care they obtain,” Dawson says.
Before making a choice, Espinosa and Dawson recommend finding out whether your preferred doctors are in-network with the plan. Next, understand how your prescription drugs would be covered. Then work with a broker or use the Medicare Plan Finder (medicare.gov/plan-compare) to identify plans available in your county, looking at copays and coinsurance amounts, out-of-pocket cost limits, and additional benefits offered.
This year’s Medicare open enrollment period — during which you can join, switch, or drop a plan — begins on October 15 and ends December 7. Start researching your options now, so you’ll be prepared to make a choice in the fall.
