Good Questions to Ask Concerning the Senior Medicare Advantage Plan

Americans eligible to receive Medicare benefits have several options to choose from when it comes to their health care coverage. One popular option is a Medicare Advantage Plan. Offered by independent insurance companies, these plans provide hospital and general medical care, plus additional benefits, such as vision and dental coverage. Because enrolling in a Medicare Advantage plan means that you are not covered under traditional Medicare, there are some important questions to ask before you sign up.

Cost

• One of the most important considerations in enrolling in a health plan is cost. Because Medicare Advantage plans vary by state, and even by county, the costs for coverage also vary. Each insurance company sets its own rates for the coverage, so be sure to ask how much the plan costs. In most cases, you will be required to pay a monthly premium for your Medicare Advantage plan, in addition to the Medicare Part B premium required by the government. Ask your insurance agent if the Medicare Advantage plan covers all or part of the Part B premium.

Out-of-Pocket Costs

• In addition to the cost of the plan, you may be required to pay co-payments or meet deductibles for your medical care. Ask about the co-payments for office visits, hospital stays, lab work and emergency room visits, as the amounts can vary for these services. Most plans have an out-of-pocket maximum, meaning that you only have to pay up to a certain amount in co-payments and deductibles before the plan picks up the rest of the cost, so be sure ask about that limit.

Types of Plans

• There are several types of Medicare Advantage plans on the market: Health Management Organizations, Preferred Provider Organizations, Private Fee for Service Plans and Special Needs Plans. Each plan has different eligibility requirements and costs, so ask about the details of each and what will work best for you. Be sure to confirm that your doctor participates in the plan, and that the network of providers in your area is adequate to meet your needs. Ask about the referral process, and what types of services require referrals.

Pharmacy Benefits

• Some Medicare Advantage plans include pharmacy benefits, also known as Medicare Part D. Confirm that the plan does include Part D and the costs of prescriptions. If you are already taking medication, be sure that it is covered under the plan and that the costs are affordable. Certain medications are covered under one plan but not others, and the costs can vary greatly between plans.

Reputation

• Be sure that your agent and company are licensed to offer the plan in your area, and check with the state bureau of insurance or your area agency on aging to make sure there are not a significant number of complaints against the company.