Depending on your needs, you may prioritize a plan with the lowest out-of-pocket costs for prescription medications, supplemental health and wellness benefits, or a large directory of in-network healthcare professionals and providers.
Private insurance companies offer Medicare Advantage (Part C) plans as an alternative to Original Medicare (Parts A and B).
Medicare Advantage plans often include prescription drug coverage (Part D), as well as supplemental health and wellness benefits.
Each plan has its own formulary and cost structure.
Medicare offers a tool to help you see which MA plans cover your current medications. You can enter in the names of the medications you take to get an idea of coverage and cost.
You can also check and see whether your pharmacy participates in the health plan you’re considering.
A Medicare Advantage plan can also provide additional benefits for services that Original Medicare doesn’t cover, including:
- over-the-counter (OTC) drugs
- gym memberships
- transportation to doctor’s visits
The importance of these benefits depends on your healthcare needs and preferences.
Depending on the type of plan you enroll in (HMO, PPO, PFFS, SNP), you may have preferred doctors and other healthcare professionals who are considered “in-network.”
If your plan has a network, you can save money by seeing an in-network healthcare professional.
You can check the plan’s website to see what healthcare professionals are in the network or contact a healthcare professional’s office directly to ask what insurance they take.
Medicare also has a comparison tool to help you see who takes Medicare in your area.
The cost associated with Medicare Advantage plans can vary. Some plans may have a premium, while others may not.
Plans will also range in the total out-of-pocket cost you’ll be responsible for. It’s not unusual for plans to also have a coinsurance or copay for the services you use.
The Centers for Medicare and Medicaid Services (CMS) collect data to grade a health plan’s performance.
The star ratings range from one to five stars, with five being the best. You can enroll in a five-star plan at any time.
Medicare’s search tool includes each plan’s star rating for easy comparison.
When shopping for a Medicare Advantage plan, it’s important to prioritize the benefits of care you need most. Once you’ve found a few plans that meet your needs, you can compare costs and star ratings.
Medicare offers tools to help you compare plans in your area. In addition, you can also get information from the health plan’s website or by speaking to a representative.
They can review the pros and cons of each method and offer personalized recommendations based on your preferences and health history.
Dr. Alexandra Perez is a geriatric pharmacist specializing in chronic disease state management. She has experience collaborating with healthcare providers in primary care clinics, optimizing medication regimens. She also has experience in clinical informatics partnering with pharmaceutical companies to help them leverage real world clinical data to perform research studies.