Page 17 - Evaluation for Tom Tappan
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Medicare Advantage plans -- an overview
An introduction to Medicare Advantage plans
How 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 your criteria. Below is a
the plan replaces Medicare for as long as you list of things you should consider:
remain enrolled in the plan. Advantage plans Does its network include my doctors?
are required to cover the same services as This is probably the most important criterion
does Medicare, but they may have different for many people. If one of your doctors (or
cost sharing. Some Advantage plans also other medical providers) is not in your plan's
provide additional services like dental and network, you will pay more when you see
vision benefits that Medicare does not cover. that doctor.
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' costs for your drugs.
Otherwise, it will depend on the plan's rules. If the Rx drug costs in the plan you want to
Most Advantage HMO plans do not cover out- enroll in are several hundred dollars higher,
of-network costs (again, except for you should 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 out-of-network flexibility in your choice of doctors and other
doctors' visits and treatments. 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. Also, Medicare's recommended out-of-pocket (or
Advantage plans attract healthy enrollees, OOP) limit is $3,400, although most plans
which helps keep costs low. have much higher limits. In Advantage HMO
What added benefits do they have? plans, the out-of-pocket limit applies only to
Advantage plans often provide some routine network services. Premium payments do not
dental and vision benefits (neither of which count toward OOP limits.
is covered by Medicare). Some plans also Does it have a good quality rating?
offer free health club memberships, Medicare uses a five-star rating to judge a
telephone hotlines for medical questions, plan's quality (five stars is best). The ratings
and wellness classes. A few plans even are based on more than 40 measures that
rebate some of your Part B premium. include customer satisfaction.
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