How to choose the best medicare advantage plan for you

How to choose the best medicare advantage plan for you

You have lots of tools to help with your choice

Published: October 2014

In the months leading up to the fall Medicare open enrollment season, your mailbox may be overflowing with sales brochures from Medicare Advantage plans. Our advice is to ignore them. There are better, unbiased ways to pick the right plan for you.

First and most important is to read the Annual Notice of Change. This is a notice your Advantage plan sends you in September. It will tell you if there are going to be any changes in your plan in the coming year. Sometimes you will find that your plan is no longer being offered.

If you like the plan you have, you don't have to do anything. But it's a good idea to check anyway to see if you can get a better deal with another plan.

Finding plans available in your area

Your first stop should be the plan finder on Medicare's website, Medicare.gov. On the home page (pictured above), click on the green button titled "Find health & drug plans" to get started. Follow the screen instructions carefully and you should be ok. If you mess up, you can always start over.

After you have entered your ZIP code, you will be asked to list the drugs you take and the drugstores you like to use. It's very important to give this information if you take any drugs on a regular basis. The plan finder will use the information to figure your exact yearly cost for your drugs over the coming year. It will even tell you whether and when you will enter the donut hole.

If you don't put in this information, you will be shown the average drug cost for people on this plan.

Even if you are not planning to change plans, you should enter this information every year. Just because your drugs were on your plan's "preferred" list this year does not mean they will be on it next year. Plans change their drug lists frequently.

Once you have finished answering all the questions, you will come to a page titled "Refine your plan results." Check the box that says you want to see "Medicare Health Plans with drug coverage." Finally click the brown box that says "Continue to Plan Results."

Choosing your plan

The first thing to do is make sure you are seeing all the plans in your area. At the top of the list you will see a choice between seeing just 10 plans or seeing all of them. Ask to see all of them.

The plans will be automatically sorted in order of annual cost. But don't buy just based on that. Here are other things to look for that may be more important.

Quality ratings. Medicare gives star ratings for health plan quality, with the top rating being five stars. The stars rate things such as customer satisfaction and the quality of care the plan delivers. We recommend selecting a plan with 3.5 stars or more. Plans with the top ratings of four or five stars get extra money from the government to spend on your medical benefits. Also check out NCQA's rankings of Medicare Advantage plans. Click on your state and choose "Medicare HMO" or "Medicare PPO."

Co-pays, deductibles, etc. If you click on a plan's name, you will be able to see the details of the plan. Look to see what you will have to pay for a doctor visit or a stay in the hospital. Look for the annual out-of-pocket limit. This is the most you would have to pay out of your own pocket in a year if you had some kind of catastrophic medical expense. If it is more than you think you can afford, you might be better off paying a slightly higher premium to get a lower out-of-pocket limit.

List of participating doctors and hospitals. With very few exceptions, Medicare Advantage plans have provider networks. If you do not use a hospital or doctor in the plan's network, it will either pay nothing or very little. If you click on a plan's name and scroll down on the resulting page, you can see how many doctors take part in the plan. You can also click on a link that will take you to the plan's website so you can look to see whether your doctors and hospital take part. You can also ask your favorite doctors what Advantage plans they take part in and which ones they recommend.

Dental and vision coverage. Many Advantage plans come with some dental and vision coverage. On the listing, you will see small circles that have a D or V in them if they have this kind of coverage. You can click on the plan name, then on the "Health Plan Benefits Tab," then on the link that says, "View More Detailed Cost & Benefit Information." There you will see the details of dental and vision coverage.

Coverage while traveling.  Many plans will only pay for emergency care when you are away from home. If you divide your time between two homes or pay extended visits to your adult children, this could pose a problem if you need something routine such as a lab test. A few plans have national networks you can use, but you can't see this information on Medicare.gov. You will have to call the plan directly to ask about it. The plan's listing on Medicare.gov has numbers for you to call.

For more questions to consider, here’s a useful list from the Medicare Rights Center.

Starting or changing your plan

Once you have selected your plan, you can enroll online right at Medicare.gov or you can call 1-800 MEDICARE. You can also enroll directly with your chosen insurance company or through an insurance broker. You don't have to cancel your old plan. It will automatically come to an end when your new one starts.


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