Choosing the Right Medicare Advantage Plan for Your Needs

Which Medicare Advantage Plan is Right for Me?

If you've decided to go with a Medicare Advantage plan, be sure to watch this video before choosing a specific plan to enroll into.

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Hi There. Steve Thurmond here with Medigap Tennessee. Your source for Medicare Supplemental, Medicare Advantage, Prescription Drug and Dental plans in Tennessee. Today I’m going to talk about Medicare Advantage Plans and how to properly choose the best plan for you and your specific needs.

Whether you’re just aging into Medicare and have decided that a Medicare Advantage Plan is right for you or whether you currently have a Medicare Advantage plan and want to change plans during AEP (the Annual Election Period of Oct 15th – Dec. 7th). This video will give you the information you need in order to make the best choice from the Medicare Advantage Plans available to you.

Now, I’ve covered the Pros and Cons of Medicare Advantage plans at length in another video, so if you’re still on the fence as to whether a Medicare Advantage plans is right for you, I suggest watching that video first. Just look for “Medicare Advantage Pros & Cons” under our Medigap Tennessee youtube channel.

If you don’t feel like watching anymore videos and you just want some help choosing a plan give us a call and we’ll walk you through the entire process. We’re contracted with all of the companies that offer Medicare Advantage plans in Tennesee, so we can show you all of your options and help you choose the best plan for your specific needs.

In this video, I’m assuming you’ve decided that you’re going with a Medicare Advantage plan as opposed to keeping Original Medicare and adding a Medicare Supplemental Plan and Stand Alone Prescription Drug plan.

I do recommend the latter over a Medicare Advantage plan, but a Medicare Advantage plan CAN be a good fit for some individuals. So, if you’re set on a Medicare Advantage plan and just need some help deciding which specific plan and from which specific company to go with, this video will help you make that decision. Full disclosure here…CMS (The Center for Medicare and Medicaid Services) does not let me tell you which plan I think is the best so, I won’t be telling you which plan to enroll into in this video.

But, what I will be doing is telling you what factors should weigh in the most when making your decision. Medicare Advantage plans vary from state to state, but in Tennessee, there are 7 different companies that offer Medicare Advantage plans. Those companies are, in alphabetical order, Aetna, Amerigroup, BlueCross BlueShield, Cigna-HealthSpring, Humana, United HealthCare and Wellcare.

Some of these companies only have a few Medicare Advantage plans to choose from, while others have multiple plans that can vary from county to county.

Not every plan is the same in every county, so you want to be sure you’re looking at the correct plan for the county in which you reside. Once you’ve narrowed down your choices to a few different plans from a few different companies, these next points I’m going to make should be the biggest factors to take into consideration when ultimately deciding on a plan to enroll into. I’ve listed them in order of their importance.

Some points may be more important to you than others, but this is just a general perspective when taking an initial glance at all of your options.

1.) Prescription Drug Coverage:

Not all Medicare Advantage plans include Prescription Drug coverage, but ever company offers at least one plan that DOES include Presciption Drug coverage. Unless you’re a veteran and get your medications from the VA at little to no cost, you want to go with a Medicare Advantage plan that DOES include presciption drug coverage.

These plans are called MAPD plans (for Medicare Advantage Prescription Drug plans)  Now, I list this point first, simply because a lot of these plans have many sublte differences, as far as premiums, copays, coinsurance, networks, ect…, but these plans can have very different drug formularies and drug copay amounts from company to company and from plan to plan.

Because of this fact, choosing a plan with a drug formulary that doesn’t cover your specific medications can be a very costly mistake. Obviously it won’t matter much if you’re not taking any serious medications or not taking any meds at all, but if you’re on any serious medications, especially any brand name medications, it is crucial that you make sure the Medicare Advantage plan’s drug formulary covers YOUR specific medications. Not doing so, will not only cause you a serious headache when trying to get an exception for your meds, but could also cost you a small fortune each year as you may end up paying full price for a specific medication that isn’t covered under the plans drug formulary.

So, the first thing that should narrow your search is making sure your specific medications are covered under a Medicare Advantage Plan’s drug formulary.

A few other things to be mindful of in this regard is whether your drugs require prior authorization from the plan or whether they have any limitations for being filled on an ongoing basis. Your drugs might be listed in the plans drug formulary, but also might require your doctor to submit paperwork to the plan in order to get them prescribed and covered when you have them filled at your pharmacy of choice. Phone calls and paperwork are not fun when you just need your meds filled.

2.) Networks:

All Medicare Advantage plans have networks to deal with…yes, even the PPO plans. If you have a current doctor that you want to stay with, it’s very important to make sure that your doctor accepts the Medicare Advantage plan that you’re interested in, regardless of whether it’s an HMO plan or a PPO. Not doing so will force you to choose another doctor if your current doctor doesn’t accept the plan you want to enroll into. This also goes for your specialists and your hospital of choice.
Now, you may have heard that you can see any doctor you’d like with a PPO Medicare Advantage plan.

Well, that’s partially true. PPO stands “Preferred Provider Organization”. With a PPO plan you can go outside of network to see other doctors, but what you might not be aware of is that if you do go outside of your PPO network, you may pay up to 50% more for your services. And furthermore, it’s up to the DOCTOR as to whether they want to accept your PPO Medicare Advantage plan as payment. It’s their decision, not yours.

The best rule of thumb is to make sure your primary care doctor, your specialists and your hospital of choice accepts the Medicare Advantage Plan you’re interested in… regardless of whether it’s an HMO plan or a PPO plan. This will just save you a lot of frustration, phone calls and paperwork down the road.

3.) Costs:

All Medicare Advantage plans have ongoing out of pocket costs. This is one of the main differences between Medicare Advantage plans and Medicare Supplemental plans.

Now, there are some zero premium plans that don’t cost you anything EXTRA on a monthly basis, but even those plans have ongoing costs like copays and coinsurance for specific services and procedures as well as an annual “Maximum out of Pocket” figure.

Don’t let the zero-dollars-per-month price-tag fool you…they always get their money one way or another. These ongoing out of pocket copays, coinsurance and Maximum out of Pocket costs will vary from company to company and from plan to plan, but a lot of the comparable plans aren’t that different in price when it comes to these ongoing out of pocket costs.

You’re looking at minimal differences of $5-$10 dollars for doctor and specialist visit copays and $20-$50 dollars differnce in coinsurance costs for specific services and procedures. The one factor that can have a bigger impact is the annual “Maximum ouf of Pocket” figure between these different plans. Most, in fact, I think all of the Zero premium plans currently available in the market have a $67000 “Maximum out of Pocket” figure attached to them.

Some of the plans that have an ongoing monthly premium do have lower “Maximum out of Pocket” figures but the monthly premium price for these plans rarely justify the savings. If you’re considering a Medicare Advantage plan that has a Monthly premium attached to it, you’re much better off spending a bit more for a Medicare Supplemental plan and putting yourself at much less financial risk with much better coverage.

4.) Bells & Whistles

So, the entire point of having a “Medicare Advantage plan” is that you get extra protection, benefits and bells and whistles with the plan that you wouldn’t get from just original Medicare. Just like my three previous points, these extra benefits are going vary from company to company and from plan to plan. Most plans offer an extra allowance for glasses or contacts on a yearly or every two years basis. How much allowance varies from plan to plan.

Some plans offer preventive dental benefits, but most of those plans have an ongoing monthly premium attached to them and you’re typically better off with just going with one of the zero-premium plans and then adding a stand-alone dental plan that includes much better coverage and usually at a lower cost.

A lot of the plans offer a free fitness or gym membership via Silver Sneakers or Silver & Fit. This is a great perk that can help you keep active and in shape as there are several locations that accept this benefit like your local YMCA, Curves Fitness, Anytime Fitness and many others. It’s usually not hard to find a location close to where you live that accepts Silver Sneakers or Silver & Fit.

In my opionion, the Maximum out of Pocket figure is the best extra protection that comes with a Medicare Advantage plan. It may have sounded like I speaking disparagingly about it earlier, but it’s actually a great added feature that you wouldn’t get if you had JUST original Medicare.

If you have JUST original Medicare as your only coverage, you are respondible for 20% of all medical costs and there is no limit or cap on that 20%. With the built in Maximum out of Pocket figure that comes with Medicare Advantage plans, you at least have a cap on the financial risk you can incur on a yearly basis.

As mentioned earlier, most Medicare Advantage plans have a yearly Maximum out of Pocket cost of $6700 So, you know no matter what may happen during the year, the MOST you’ll have to pay out of pocket during any given year is that $6700 figure. It’s easy to run up a large hospital bill in the event of a catastrophic situation or even if you just spend a few days in the hospital.
If you had JUST original Medicare as your only coverage, you could be on the hook for a $100,000 hospital bill that you’d have to pay $20,000 off. With a Medicare Advantage plan, you’d only have to pay $6700 in that same scenario. So, for that reason alone, Medicare Advantage plans are certainly better than having JUST original Medicare as your only source of coverage.

There are a few other benefits here and there that vary from plan to plan, but these are some of the main ones that might make a difference in your final choice.

5.) Plan Star Ratings:

Every Medicare Advantage plan has a Star rating from 1 – 5. One being the worst rating and five being the best. These ratings come from CMS (The Center for Medicare and Medicaid Services) and are based on many differnt factors. Remember, Medicare Advantage plans are Managed HealthCare plans, so the star ratings rate each plan by how well it Manages their customer’s healthcare.

The plans star rating is impacted by things like;  Keeping it’s members healthy, Managing chronic, long-term conditions, the member’s experience with the plan, member complaints, customer service, drug customer service, drug saftey, and drug pricing. These star ratings can have a heavy impact on a company’s plan as a plan that continues to have a low-star rating (like a 1 or 2) can face corrective action from CMS or be removed from the market altogether.

Most of the plans in Tennessee are 2.5 to 3.5 star rated plans. There are a couple 4 star rated plans, but there is no 5 star rated Medicare Advantage plan in Tennessee at this time.
That being said, it’s something to keep in mind when you’re choosing a plan, but not something that will have a drastic effect on you if you’re mindful of the above 4 points we’ve already discussed.

Personally speaking, I have clients that are on 2.5 star rated plans that absolutely love their plan and I’ve also moved clients from a 4 star rated plan because they hated it.

It truly is subjective and I think those that don’t like their plan, no matter it’s rating, didn’t have a good agent to guide them in the enrollment process and cover some of these main points we’ve discussed in order to avoid a bad experience.

Don’t let that happen to you. Just give us a call and we’ll walk you through the entire process and show you ALL of the options available to you in your specific market, so that you can choose the best Medicare Advantage plan for your specific needs.

Remember…Medicare doesn’t cover everything…so give us a call at 1-800-431-5431 and let us help you zap-the-gap!

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