Comparing Medicare Advantage Plans
Comparing Medicare Advantage Plans
When you are Comparing Medicare Advantage, there can be extra benefits also known as Medicare Part C plans. Many customers enjoy the convenience of having all health and drug plans under a single membership. Instead of enrolling in a stand-alone Medicare Prescription Drug Plan (Part D plan) many look at an alternative for extra benefits with the drug plan built into it.
If you are looking for a plan that has Dental, Hearing, Vision built into a plan let’s explore more of what Medicare Advantage or Part C of Medicare is.
WHAT IS A MEDICARE ADVANTAGE PLAN?
Medicare Advantage plans compliment and are very comparable to Original Medicare, Part A and Part B. Instead of having Medicare benefits administered through the government program, beneficiaries can choose to get their coverage through a Medicare Advantage plan, available through private insurance companies that have a yearly contractual agreement with Medicare.
TO BE ELIGIBLE FOR MEDICARE PART C, YOU MUST…
- Enrolled in Medicare Part A and Part B.
- Living in the plans service area determined by the county of Medicare Advantage plan offering. (Medicare.gov)
- Not have end-stage renal disease (with some exceptions).
Medicare Advantage carriers have an agreement with the Federal Government that plans must provide the same level of coverage as Original Medicare, Part A and Part B (except for hospice care, which Part A still covers). The Advantage of Medicare Advantage is many plans may cover additional benefits, such as prescription drugs, hearing, routine vision and dental, or health wellness programs.
Unlike Original Medicare, if you want prescription drug benefits (Medicare Part D), you shouldn’t enroll in a separate Medicare Prescription Drug Plan. Instead, you can get this benefit through a Medicare Advantage Prescription Drug plan. You will want to check with Medicare Advantage plans if a client is looking not to include Prescription drug coverage with their Medicare Advantage plan. Not all Medicare Advantage plans include the Part D plan.
HOW TO COMPARE MEDICARE ADVANTAGE PLANS
These types of plans are available through Medicare-approved private insurance companies, the costs and benefits may vary by plan, and year. Not every plan will be available in every location, there are different types of plans when looking into what coverage a client need. Here are some considerations to decide when looking at Medicare Advantage plans:
- What does the monthly premium all include? Some Medicare Advantage plans may have premiums as low as $0, but clients still need to pay Medicare Part B premium, along with any copayments, coinsurance, or deductibles according to your plan.
- Is there an annual deductible?
- What are some of the extra benefits? Does the plan include additional benefits, such as routine vision or dental, hearing, or health wellness programs?
- Are all my providers in the network? (Please note that provider and pharmacy networks may change at any time; you’ll be notified by your Medicare plan if necessary)
- What is the MOOP (Max out of Pocket)? Every plan has a safety net that will cover 100% if the member hits that cost per calendar year. Unlike Original Medicare, every Medicare Advantage plan has a yearly maximum spending limit; once you reach this limit (which includes the deductible), the Medicare Advantage plan covers 100% of covered medical costs for the rest of the year.
- Does the plan include prescription drug coverage?Make sure current medications are included in the plan’s formulary. What is the copayment and coinsurance costs for the drugs the client takes? (Please note that the formulary is subject to change; you’ll be notified by your Medicare plan if necessary.) Connect4Medicare helps determine what is best for the client’s needs.
- Look for the plan’s star rating? Star ratings are based on the private insurer’s performance review. Each plan is given a rating between 1 to 5 stars, with 5 stars being the highest score.*
*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. CHECK THE PLANS SUMMARY OF BENEFITS FOR MORE DETAILS.
Medicare is not a “one size fits all”, as a professional we want to carefully research Medicare Advantage plan options to make sure this is the best fit for our clients’ needs and budget. Every AEP (Annual Election Period) it is good idea to review the clients coverage every year and make sure it’s still a good fit for their specific needs.
Pinnacle helps our agents help the clients by using Connect4Medicare along with other tools to help determine what is best for clients Medicare needs.
Pinnacle will help you find Medicare plan options based on location, insurance company, premium cost, and benefits the client needs. Our plan finder tool is a convenient way for you to compare plan details side-by-side to ensure that the most important aspects of your health-care needs are covered.
If you’d prefer to get help over the phone, you can also give us a call to speak with one of our dedicated support staff to help 1-800-772-6881 x7731.
Contact Pinnacle Financial Services today for more information on insurance agent E&O coverage.
