About 58 million people are currently enrolled in Medicare -- roughly 18% of the U.S. population -- and close to 20 million of them are actually enrolled in "Medicare Advantage" plans instead of the version of Medicare, "original" Medicare, that most people are familiar with.
If you're not already in a Medicare Advantage plan, you should consider enrolling in one -- or planning to, if you don't yet qualify for Medicare. The plans are not best for everyone, but they are best for many, and according to a 2015 survey, 91% of Medicare Advantage enrollees reported being satisfied with their coverage, with a whopping 69% reporting being highly satisfied.
Here are three smart Medicare Advantage moves most of us would do well to make.
Learn what's great and not great about Medicare Advantage plans
Backing up a bit, understand that there isn't a single Medicare plan. Each enrollee needs to choose either "original" Medicare or a Medicare Advantage plan. Traditional or "original" Medicare features Parts A and B that respectively cover hospital expenses and medical expenses. If you opt for it, you'll likely add Part D, which offers prescription drug coverage, including insulin supplies, and you might add on a Medigap plan, as well, for additional coverage.
Instead of all that, though, you can choose a Medicare Advantage plan. Offered by private insurance companies, they are required to provide at least as much coverage as Parts A and B -- and they usually offer significantly more. Here are some reasons to favor Medicare Advantage plans:
- Many Medicare Advantage plans, unlike original Medicare, cover hearing, vision and/or dental care. Medicare Advantage plans also typically include prescription drug coverage.
- A Medicare Advantage plan can cost you less. Original Medicare will often have you footing 20% of many bills with no limit on how much you might have to pay out of pocket. (Paying only 20% can seem OK until you get a bill for $50,000 and suddenly have to cough up $10,000.) A Medicare Advantage plan might charged you a certain copay per doctor visit or service, and many services will simply be paid for through your premium. Medicare Advantage plans also feature out-of-pocket spending caps. (The average out-of-pocket cap was recently $5,223, but many plans feature caps below $3,000 and the limit for 2017 is $6,700.) Once you hit the cap or limit, the plan will pay all further costs. Better still, many plans charge the enrollee nothing in premiums. (The Medicare program pays the insurance company offering it a set sum per enrollee and if the insurer thinks it can make a profit without charging its customers anything, it can do so.) The average monthly premium for Medicare Advantage plans was recently $33.
- While original Medicare can't be used outside U.S. borders, some Medicare Advantage plans offer coverage abroad.
Of course, Medicare Advantage plans aren't perfect. Here are some downsides:
- It can be hard to compare Medicare Advantage plans, because of their different costs and fee structures and the different kinds of coverage they offer.
- A Medicare Advantage plan won't necessarily cost you less than original Medicare would.
- While original Medicare lets you see any healthcare provider in the country who accepts Medicare (and most providers do accept it), Medicare Advantage plans work differently. They often operate as HMOs or PPOs, limiting you to a network of doctors -- though these networks are sometimes very big. But even with a big network, if you travel frequently, you may find yourself far from service providers in your network.
- Medicare Advantage plans may require you to follow certain rules regarding getting care, such as getting a referral to see a specialist from your primary care physician.
- If you have a Medicare Advantage plan that you like, it may not be around next year. The insurance companies offering Medicare Advantage plans have contracts with Medicare that are not always renewed from year to year. Even when renewed, some terms of the plan may change, such as which drugs are covered.
- Some members have reported that getting emergency or urgent care is more difficult with a Medicare Advantage plan than with original Medicare. It can be worth looking into how emergency care will work in any plan you're considering.
Decide whether a Medicare Advantage plan is for you
Once you're informed about Medicare Advantage, you can decide whether it's for you or not. Look into all your options and see which makes the most sense for you. Do the math, comparing premiums, copays, deductibles, and so on -- to see which plan is likely to cost you the least and/or offer more coverage. Take a close look at any plan you're considering and compare it with original Medicare, keeping your health profile and likely healthcare needs in mind. For example, if most of your healthcare costs are related to prescription drugs, see which plan offers the best deal related to the drugs you take. If you are very attached to one or more particular doctors, find out if they're in the network of any plan you're considering.
Know, too, that the Medicare system rates Medicare Advantage plans (and Part D plans) with up to five stars, so look for plans with higher star ratings, as they will likely serve you best. Medicare Advantage plans earn their stars by being evaluated on measures such as how well they're keeping their members healthy (via screenings, checkups, and more), how well they're managing members' chronic conditions, and how good their customer service is. You'll find the star ratings of plans available to you by using the Medicare Plan Finder at the Medicare website. (Another nifty thing about five-star plans is that they don't limit you to the usual enrollment period. If you're switching into a five-star plan, you can do so throughout most of the year, from December 8 through November 30.)
Note that if you choose original Medicare or a Medicare Advantage plan and you're not happy with it, it's not a permanent decision. You can switch between plans in any year during the annual enrollment period.
Make the most of your Medicare Advantage plan
A final smart move regarding Medicare Advantage plans is to make the most of any plan you sign up for. Don't just go to the doctor when you're very sick or injured -- be proactive about your health.
Both original Medicare and Medicare Advantage plans offer lots of preventive screenings at no extra cost to you -- such as mammograms and colonoscopies. Get screened for cancer, diabetes, and anything else your doctor deems sensible. You're also entitled to an annual wellness visit at no extra cost to you, where you and your doctor can discuss your health, your goals, and how you might reach them. You may be able to access smoking cessation or weight-loss counseling, too, at little to no extra cost, and some plans may offer discounts on gym memberships or other wellness benefits, too.
Find out whether your plan offers "telemedicine" benefits, which give you access to doctors and other providers via the telephone or Skype-like video calls. You may not want to haul yourself all the way to your doctor's office if you're not feeling well -- and a telemedicine consultation may be a good solution, or at least a starting point. Telemedicine is becoming more widespread, so look into it.
Medicare Advantage plans are well worth considering -- and even original Medicare can serve you very well, too. Learn more about them so that you can make informed decisions that keep your pocketbook and your body as healthy as possible.