6 Questions You Need to Ask Before Enrolling in Medicare Advantage

Shopping for Medicare coverage can feel like visiting an ice cream parlor. Trying to figure out what option is the “best” choice can be daunting.

To help you narrow down your choices and help select a plan you can be happy with, we’re sharing the six questions you need to ask when looking at Medicare Advantage plans.  

These questions help you narrow down your plan needs and address them without feeling the overwhelming choice paralysis that comes with having so many options.

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

1: Are all of my current doctors and specialists inside the plan's network?

There’s nothing worse than finding out after you’ve enrolled in an insurance plan that one of your providers isn’t covered. Maybe it’s a specialist you need or the trusted primary care physician you’ve been seeing for years. Either way, it’s not fun to find out your plan doesn’t cover that visit.  

Luckily, that headache can be avoided by researching your plan’s network before enrolling. Like with other private insurances you’ve dealt with throughout your life, Medicare Advantage plans have networks.

By researching plan networks and ensuring your doctors and specialists are all covered before enrolling, you’ll avoid coverage issues later on.

2: If I were to be hospitalized, what would my out-of-pocket costs be? Am I OK with that?

Hospital costs can be incredibly stressful. The thought of having to be in the hospital overnight, or even for multiple days, can be a huge financial stress.

When considering a Medicare Advantage plan, you should not only make sure your local hospitals are in-network, but you should also look at your financial responsibility under the plan.

Your plan information should give you an estimate of out-of-pocket hospital costs. It's critical to understand your deductible as well as coinsurance or copays that apply for inpatient hospital stays.

If hospital stays are something you anticipate, this is something to seriously consider before enrolling in a plan. And even if you have no plans to visit the hospital, accidents or unexpected health events can happen.

You don’t want a big bill to be the finale to an already difficult experience.  

3: Am I comfortable with a managed care plan?

Medicare Advantage is a managed care plan, meaning it does have a say in the types of treatment plans you can get for different medical conditions.

In many cases, a Medicare Advantage plan will require you to try a lower-cost treatment plan or medication before it will approve a more expensive one. This can cause headaches, especially if your doctor believes a certain treatment plan is right for you but cannot administer it because of your insurance plan.

It's important to understand that this is a component of all Medicare Advantage plans.

4: Am I OK with accepting a lower premium upfront but taking on more costs if I actually use the plan?

Part of what makes Medicare Advantage appealing is that it can offer lower – sometimes even $0 – premiums upfront. However, that typically translates to larger copays later.

Some people like the lower premiums, especially if they are in good health and don’t worry about the increased payment on a low volume of services.

If, however, you do have health issues that require frequent visits, tests or procedures, you’ll have to decide if the lower premium/higher copy option is the most cost-effective solution for you.

5: Are my prescriptions going to be covered?

Prescriptions are a common cost concern when looking at plans. And it’s important to find a plan that is compatible with your needs.

I knew someone who thought she had chosen the perfect plan until she found out her arthritis medication wasn’t covered. It costs hundreds of dollars per month! Luckily, she was able to find a solution that didn’t end up costing a fortune. But the fact remains: Prescriptions can be pricey.

When reviewing any prescription coverage, you need to make sure that not only are your prescriptions compatible, but that your pharmacy is, too. There’s no point in saving a few dollars on a pill if you have to drive half an hour to get to the pharmacy.

Knowing your covered prescriptions and pharmacies before enrolling is a big part of making sure you choose a plan that works for you.

6: What plans are available in my area?

Medicare Advantage plans are determined by county. Knowing what plans are available in your area lets you not only compare plans, but pricing as well.

Here at Medicare Allies, we can help you find plans available in your county. Talking with a licensed insurance agent about your options helps you make sure you are getting clear information to help you make your coverage decision.

Conclusion  

Finding the right Medicare plan for you is key. You have unique concerns and needs that are different from anyone else. These six questions will help you refine your focus to find the plan option that will work for you.

And please, give us a call! We are here to help you navigate Medicare Advantage and any other coverage questions you may have.