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Decipher Medicare Advantage

Industry News | Oct 06, 2016



Not all Medicare Advantage plans work the same way and because of this, it can be confusing when trying to develop a complete understanding of these plans.

Medicare Advantage plans are offered by a private company to provide all of your Part A and Part B needs. Health maintenance organizations and preferred provider organizations are two of a handful of various groups to offer Medicare Advantage.

Because of how wide Medicare is, you may find that a private Advantage plan suits your needs better than an Original Medicare plan. According to the Kaiser Family Foundation, nearly 17 million Americans are enrolled in a Medicare Advantage plan and benefit from doing so.

But before you sign up for the first plan you see from a private provider, you want to conduct as much research as possible. Here are some ways you can decipher Medicare Advantage.

Look at the stars

Each Medicare Advantage plan is rated by a specific number of stars. The highest a plan can be rated is five stars. The rating descriptions are as follows:

  • 1 star - Poor
  • 2 star - Below average
  • 3 star - Average
  • 4 star - Above average
  • 5 star - Excellent

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

It's in your interest to enroll in a plan that has a higher star rating. According to The Motley Fool, these ratings take into account how well patients are kept healthy, customer service levels and the management of patients' chronic conditions or illnesses.

"Each Medicare Advantage plan is rated by a specific number of stars."

Five-star plans are only available if one is in your area. But if you do have a 5 star plan available in your area, you can make the switch to that plan any time during the year.

Why should I switch?

The benefits of Medicare Advantage plans vary and will depend on your specific health needs. But since Part A and Part B coverage options are included and prescription drug coverage can be included, you won't need to worry about signing up for another plan.. This one plan will manage your medical and prescription drug benefits.

Financially, some Advantage plans may cost you less than Original Medicare. Don't be surprised if a company doesn't charge a premium for your Medicare Advantage plan.

Out-of-pocket charges will also differ depending the specific plan. The maximum out of pocket limit is what you spend on health costs annually, but once you hit a specific limit, you won't have to pay anything. Keep in mind that these limits can also change on a yearly basis, but your provider will inform you if they do.

Other health options can also be included in Medicare Advantage plans. Vision and dental coverage are aspects that can be included in an Advantage plan you enroll in. Otherwise, Medicare doesn't cover routine eye exams if you wear glasses or contact lenses.

Since there are so many Advantage plans to choose from, you'll able to find one that tailors to your needs. For example, you may not have any serious health conditions, but you always need a yearly eye exam. If this is the case, seek out a plan with strong vision coverage.

Likewise, if you need a lot of prescription drugs, look for a plan that includes Part D to help you with the medications you need. The good news is that most Advantage plans offer prescription drug coverage, but you'll want to make sure the specific drugs you need are included.

"Most Advantage plans offer prescription drug coverage."

Don't hesitate to switch

The Medicare Advantage plan you sign up for one year may no longer meet your needs as time passes. Don't let yourself be automatically re-enrolled in a plan. Luckily, you can switch from one Advantage plan to another during any time of the year.

If you do decide to go with a different plan, you'll be disenrolled from the old one automatically once coverage starts for the new Advantage plan. The automatic renewal helps make the transition process so you don't have to worry too much.

With the enrollment period quickly approaching for Medicare Advantage, now is the time to look into the health care services you need. Just remember to find out all the details you can because plans will differ in what they cover and their rating.