Page 18 - Evaluation for Jeanne Huybrechts
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Medicare Advantage plans -- an overview
An introduction to Medicare Advantage plans
Do Advantage plans supplement Plan Selection Criteria
Medicare?
Advantage plans are sometimes referred to Before you enroll in an Advantage plan,
as replacement coverage. That means that make sure it meets certain criteria. Below is
the plan replaces Medicare for as long as a list of things you should consider:
you remain enrolled in the plan. Advantage Does its network include my doctors?
plans are required to cover the same services This is probably the most important criterion
as does Medicare, but they may have for many people. If one of your doctors (or
different cost sharing. Some Advantage plans other medical providers) is not in the plan's
also provide additional services like dental network, you will pay more when you see
and vision benefits that Medicare does not that doctor.
cover. Is it a low-cost plan for my drugs?
What if I see a non-network doctor? When evaluating an Advantage plan,
In the case of an emergency, you will be compare its costs for the prescription drugs
covered when you go out-of-network. you take to other plans' cost for your drugs.
Otherwise, it will depend on the plan's rules. If the cost in the plan you want to enroll in is
Most Advantage HMO plans do not cover out- several hundred dollars higher, you should
of-network costs (again, except for probably look elsewhere.
emergencies). Advantage PPO plans do cover Does it have a large network?
out-of-network care, but you will have Large-network plans give you greater
higher cost-sharing for doctors' visits and flexibility in your choice of doctors and other
perhaps for tests that doctors order. providers, particularly if you need a referral
How can plans have zero premiums? to see a new specialist.
Medicare makes monthly payments to plans Is the plan's out-of-pocket limit low?
that cover most of your costs. And Medicare's recommended out-of-pocket
Advantage plans attract healthy enrollees, limit is $3,400, although plans are allowed to
which helps keep costs low. have much higher limits. In most Advantage
What added benefits do they have? HMO plans, the out-of-pocket limit applies
Advantage plans often provide some dental only to network services. PPO usually have
and vision benefits (neither of which is much higher limits.
covered by Medicare). Some plans also offer Does it have a good quality rating?
free health club memberships, telephone Medicare uses a five-star rating to judge a
hotlines for routine medical questions, and plan's quality (five stars is best). To some
wellness classes. A few plans even rebate extent, the ratings indicate whether a plan's
some of your Part B premium. enrollees like it or not.
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