How Can You Tell if a Medicare Plan is the Right Fit for You?
Everyone’s healthcare needs are a little different. The ability to find customized benefits that meet those needs is one reason why a majority of eligible consumers now choose Medicare Advantage (MA) plans offered by private insurers as a substitute for Original Medicare. MA plans, also called Medicare Part C, almost always provide additional coverage that goes beyond what’s included in Original Medicare.
That’s where it gets tricky: When you start shopping around for an MA plan, you’ll quickly find out that sorting through all those options can be really confusing.
A 2023 report from KFF found that the average consumer had a choice of 43 different MA plans in their ZIP codes, double the number from just five years earlier. All the growth in this marketplace might give you a lot more flexibility. However, it also means you’ll need help to figure out which plan makes the most sense for you.
Even if you’ve already signed up for an MA plan, you have yearly opportunities to review your situation and consider other possibilities. These windows include the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, and the Medicare Annual Enrollment Period from October 15 to December 7. Here are some of the key considerations that GoHealth licensed insurance agents look at when they help consumers sort through their options.
What Coverage Is Most Valuable to You?
Every MA plan provides the same coverage as Original Medicare when it comes to inpatient care like hospital stays as well as routine doctor’s office visits and many other medical services. Most also include a Part D prescription drug plan.
To narrow your choices, think about what other features would help you to live a fuller, healthier life. MA plans commonly offer coverage for:
- Dental
- Vision
- Hearing aids
- Telehealth services
Various plans will offer different levels of coverage for these services and supplies, so keep your priorities in mind as you take a close look at the alternatives.
What Additional Benefits Could Help?
Certain MA plans are loaded up with other features that would make a difference in your overall well-being and quality of life. These supplemental benefits commonly include:
- Adult day health services
- In-home support services
- Therapeutic massage
- Caregivers
Depending on their financial and health situations, some people also qualify for benefits like lower cost prescription drugs, transportation to doctor’s appointments, and even assistance paying for non-medical needs like groceries and pest control. You’re most likely to have access to the broadest range of benefits if you’re also eligible for Medicaid (referred to as dual-eligibility) because of limited income and resources or a chronic condition.
Are Your Preferred Healthcare Providers in Network?
To get the full savings from most MA plans, you will have to see doctors, go to hospitals, and shop at pharmacies that are included in the plan provider network. If continuing to receive care from a doctor you already trust and picking up drugs at the most convenient location are important to you, make certain they are in-network. You should also know whether the insurance you’re considering requires you to visit your primary care doctor for a referral before seeing a specialist.
Networks do change over time. Still, even if your doctor disappears from your carrier’s directory of in-network providers, you may not be immediately forced to see a different one. That’s because MA plans are required to maintain continuity of care in certain circumstances. However, this kind of change is a good reason to consider other plans during the next enrollment period.
What Costs Will You Need to Pay?
Healthcare costs are a concern for everyone, especially if you live on a fixed income. MA plans go a long way to make quality treatment and preventive care affordable, but you should have a clear sense of how much you’ll be responsible to pay under various circumstances.
Some costs to factor in when evaluating a plan are:
- Plan premium (for some plans, this is as low as $0)
- Part B monthly premium (plans may cover up to 100% of this cost)
- Copayment for doctor’s visits (for some plans, this is $0)
- Deductible (how much you’ll pay for services before your plan coverage kicks in)
- Out-of-pocket maximum (the most you’ll have to pay in a year before the plan covers all further costs)
If your income and resources are low enough that you’re dual-eligible for both Medicare and Medicaid or if you have a chronic condition, you may be able to save money while accessing additional services by enrolling in a special needs plan (SNP).
There are literally thousands of Medicare Advantage plans nationwide; you need honest, well-informed guidance to find one that’s available in your area and the right fit for your needs. Even if you discover a great option for this year, your situation and the benefits available to you may change over time. Check with a licensed insurance agent to review your choices and decide whether to stick with your current plan.
About GoHealth
GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.
