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Comparing Medicare Advantage Plans

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There can be many benefits to Medicare Advantage, also known as Medicare Part C. Perhaps you prefer the convenience of having all of your health and drug benefits under a single plan, instead of enrolling in a stand-alone Medicare Prescription Drug Plan for your Medicare Part D coverage. Or you may be looking for extra benefits that Original Medicare doesn’t cover, such as routine vision and dental coverage.

Here’s an overview of Medicare Advantage plans, including how they work and what to consider when comparing plan options.

What is a Medicare Advantage plan?

Medicare Advantage plans are an alternative to Original Medicare, Part A and Part B. Instead of having Medicare benefits administered through the government-run program, beneficiaries can choose to get their coverage through a Medicare Advantage plan, available through private insurance companies that contract with Medicare.

To be eligible for Medicare Part C, you must:

  • Have Medicare Part A and Part B.
  • Live in the service area of the Medicare Advantage plan you’re considering.
  • Not have end-stage renal disease (with some exceptions).

By law, all Medicare Advantage plans must provide at least the same level of coverage as Original Medicare, Part A and Part B(except for hospice care, which Part A still covers). However, some plans may also 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. Not every Medicare Advantage plan includes prescription drug coverage, so always double-check with the specific plan you’re considering.

How to compare Medicare Advantage plans

Because Medicare Advantage plans are available through Medicare-approved private insurance companies, the costs and benefits may vary by plan, and not every plan will be available in every location. When comparing Medicare Advantage plan options, there are many factors to take into consideration:

  • Does the monthly premium represent a good value? Some Medicare Advantage plans may have premiums as low as $0, but remember that you’ll still need to keep paying your Medicare Part B premium, along with any copayments, coinsurance, or deductibles that your plan requires.
  • Is the annual deductible amount something you are comfortable with?
  • What are the initial coverage and out-of-pocket limits? 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 additional benefits, such as routine vision or dental, hearing, or health wellness programs?
  • Does the plan include prescription drug coverage? Are your current medications included in the plan’s formulary, or list of covered drugs? What are the copayment and coinsurance costs for the drugs you take? (Please note that the formulary is subject to change; you’ll be notified by your Medicare plan if necessary.)
  • Does the plan have a provider network? If so, are your current doctors and health-care providers included? (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 plan’s star rating? Star ratings are one way to gauge a Medicare Advantage plan’s performance. Each plan is given a rating between 1 to 5 stars, with 5 stars being the highest quality 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.

Every person is different, so you’ll want to carefully research Medicare Advantage plan options in light of your specific health needs and budget. Keep in mind that plan costs, benefits, service areas, and provider networks may all change from year to year, so it’s a good idea to review your coverage every year and make sure it’s still a good fit for your situation. Taking the time to shop around and compare Medicare Advantage plan options in your area could save you money on out-of-pocket costs.

If you’re ready to start browsing plan options, eHealth’s Medicare plan comparison tool may be useful. You can find Medicare plan options based on location, insurance company, premium cost, and more. 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 a licensed insurance agent. Contact eHealth today to get customized assistance with your Medicare coverage needs.

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