Medicare Advantage ads promise extra benefits and low premiums, and every carrier seems to offer something a little different. Sorting through them gets much easier once you know what matters most to you.
Medicare Advantage, or Part C, gives you another way to get your Medicare benefits. Instead of the federal government paying your claims, a private insurer that contracts with Medicare handles your coverage. You still get every hospital and doctor service Original Medicare covers, and many plans fold in drug coverage, dental care, eye exams and hearing aids.
Starting With Your Own Priorities
Before comparing plans, take stock of your health care needs. Think about the doctors you see regularly, the hospitals you trust, the medications you take and the services you expect to use next year.
Then decide what matters more: a lower monthly cost or more freedom to choose your providers.
Health maintenance organization plans usually keep costs down with a set network of doctors and may require a referral to see a specialist. Preferred provider organization plans give you room to see doctors outside the network, but those visits tend to come with a bigger bill.
Neither option is right for everyone. Someone with a longtime specialist may value flexibility, while someone in good health on a tight budget may lean toward a lower premium.
Either way, confirm that your doctors are in the plan’s network and that your prescriptions are on its list of covered drugs. Generous perks won’t make up for a plan that charges you heavily for the medicines you take every day.
Looking Closely at the Part B Giveback
Most people in Medicare Advantage still pay the monthly Part B premium. Some plans, however, offer a Part B premium reduction, often called the Part B giveback.
With this benefit, the plan pays part or all of your Part B premium. The savings usually show up as a smaller deduction from your Social Security check or a lower bill from Medicare, so more money stays in your pocket each month.
Read the fine print, though. Giveback amounts vary widely by plan and county, and the benefit isn’t offered everywhere. People whose Part B premium is already paid by Medicaid or a state assistance program generally can’t use it. Research has also linked some giveback plans to narrower provider networks and higher cost-sharing.
That is why the company helping you compare plans matters. An independent agency such as Benefit Packages, which represents multiple Medicare carriers, can line up giveback plans against the other options in your area and add up what each one would cost you over a full year, rather than focusing on the monthly credit alone. A trusted adviser should also be willing to tell you when a plan without a giveback is the better fit.
Considering a Special Needs Plan
If you live with a serious chronic illness, a chronic condition special needs plan, or C-SNP, may be worth a look. These Medicare Advantage plans are built for people with specific qualifying conditions, such as diabetes, chronic heart failure, cardiovascular disorders or chronic lung disease.
What sets a C-SNP apart is care coordination. Many plans assign a care team to help manage your treatment and shape their provider networks and drug coverage around your condition. Some plans also help you get to appointments or give you a set amount for everyday pharmacy items.
Enrollment requires a qualifying diagnosis, which the plan typically confirms with your doctor.
Comparing the Full Picture Before You Enroll
Skipping a monthly premium doesn’t guarantee you’ll spend less. Check the deductibles, co-pays, coinsurance and the yearly cap on your spending. Those costs decide what you actually pay when you need care.
Then weigh the extras you’ll really use. A gym benefit means little if you never go, while strong dental coverage could save you a lot if you need major work.
Medicare’s annual enrollment period each fall lets you review your coverage and switch if your needs change.
The best Medicare Advantage plan fits your health, your doctors, your budget and the way you like to get care. Take your time, and lean on people you trust when the choices start to blur together.
