The Medicare Advantage open enrollment season ends on March 31st. There is so much information about Traditional Medicare and Medicare Advantage—not to mention all the mailers and TV ads—it can be difficult to cut through the noise and understand what’s most important when choosing a Medicare Advantage plan.
If you’re considering changing to a Medicare Advantage plan, or switching to Traditional Medicare during open enrollment, here’s a list of important dos—and don’ts—before you make your decision.
1. Why read Medicare’s comprehensive handbook “Medicare & You 2023” (free) and visit the Medicare website for details on Medicare Advantage and Traditional Medicare plans.
2. Don’t miss the open enrollment period to switch Medicare Advantage plans or switch from Medicare Advantage to Traditional Medicare; it ends March 31.
The open enrollment period from October 15 to December 7 is to join, switch, or drop a Medicare Advantage plan or a Medicare Part D prescription drug plan.
3. Why understand the difference between Traditional Medicare and Medicare Advantage. Traditional Medicare, sometimes called Original Medicare, is a federal government program that allows you to use a doctor or hospital that takes Medicare in the US. This includes Part A (hospital insurance) and Part B (medical insurance), and you can buy Medicare prescriptions. a drug plan known as Part D and a supplemental Medicare policy known as Medigap. You pay a monthly Part B premium, and if you buy a Part D plan, a monthly premium as well.
Medicare Advantage, or Medicare Part C, is an alternative to Traditional Medicare sold by private health insurers. You must use doctors and other health care providers in the plan’s network and service area and need a referral to see a specialist. Some plans have a $0 premium.
4. Why research to see if you need a Medigap policy if you’re switching to Traditional Medicare. Medigap, or Medicare Supplemental Insurance, is a policy some people with Traditional Medicare buy from private health insurance to pay for some out-of-pocket health care costs for medical services and supplies that are covered by Medicare as well as some services that are not covered by Traditional Medicare. , like health care when traveling abroad.
5. Why get unbiased information about Medicare Advantage and Traditional Medicare by calling the State Health Insurance Program or SHIP. A SHIP advisor will not direct you to a specific Medicare plan but will be able to explain the basics to help you make an informed decision. “Some counselors may be Medicare beneficiaries themselves, which gives them personal experience of what other people are going through,” said Susan DeMarois, director of the California Department of Aging.
6. What use Medicare’s free Plan Finder tool on the website to compare Medicare Advantage Plans as well as Medicare Part D prescription drug plans and Medigap supplement policies. Plan Finder has Medicare Star Ratings for Medicare Advantage and Part D prescription drug plans to help you narrow down your potential options. These ratings, on a scale of one to five stars (five being the best) measure how well certain Medicare Advantage and Part D plans are doing for beneficiaries. If a plan gets less than three stars for three consecutive years, Plan Finder Medicare lists it as a “low-performing” plan.
7. Why call doctors to see that Medicare Advantage plans are the same, and the hospital, advises Darwin Hale, CEO and founder of Advocate Health Advisors, a national firm of Medicare brokers.
8. Why Find out what prescription drugs you take, and what dosages, are covered by the particular Medicare Advantage plan you are considering, as well as how much your out-of-pocket costs will be.
9. Why consider working with a Medicare broker to help you find a Medicare Advantage plan (as well as Medigap and Medicare Part D). Just be aware that brokers generally only sell policies from a select few companies and are always paid on commission. They did not work for Medicare.
10. Don’t buy a Medicare Advantage plan just because you see a TV ad for one or with a celebrity asking you to call an 800-number. “In many ways, it’s the Wild West when it comes to selling this product,” said David Lipschutz, associate director of the Medicare Advocacy Center.
11. Don’t choose a Medicare Advantage plan purely because of its premium, says Diane Omdahl, author of Medicare for You: The Smart Person’s Guide. You’ll also want to compare what your annual out-of-pocket limit is since Medicare Advantage plans have co-pays for most medical services. “Many people get stuck on premiums and choose one Medicare Advantage plan over another without considering all the factors,” Hale said.
12. Don’t forget that if you are traveling and need a doctor, that doctor may not be in the Medicare Advantage plan’s network. As a result, the doctor may not see you.