Medicare Advantage Pre-Enrollment Checklist

Choosing the right Medicare Advantage (Medicare Part C) plan is an important decision. It's essential to ensure that your policy meets your needs and that you can afford the premiums and copayments. 

Many people feel confused by the wide range of Medicare Advantage options available. The following Medicare Advantage pre-enrollment checklist can help you find the most appropriate policy for your circumstances. 

Medicare Advantage Pre-Enrollment Checklist: What Should I Look For?

Medicare Advantage policies with ultra-low or even $0 premiums can be an appealing prospect, but there's more to choosing the best healthcare coverage than picking the cheapest plan.

When you make a claim, policies with bargain-basement premiums sometimes come with higher copayments and co-insurance charges. Furthermore, they may not cover the treatments and services you require. This Medicare pre-enrollment checklist can uncover whether a plan offers true value for money. 

Which Providers Are In-Network?

Most Medicare Advantage plans have a network of approved healthcare providers, and you'll usually need to use an in-network clinic to enjoy comprehensive treatment coverage. Choosing an out-of-network doctor or provider often means you'll pay the costs of treatment yourself or contribute significantly more toward your care.

Bear in mind that many Medicare Advantage insurers require a referral from your nominated primary care doctor before they will cover specialist treatment. 

Many people have a preferred healthcare provider and pharmacy before enrolling in a Medicare Advantage plan. If this applies to you, you should check that your preferred providers are part of your insurer's network or that there is another in-network provider you're prepared to use. 

What Is the Coverage Area?

Generally, Medicare Advantage plans have a restricted coverage area of a single county. However, some cover multiple counties or wider regions to meet the needs of rural enrollees who may live a long way from their nearest healthcare provider. 

Therefore, it's essential to check that your Medicare Advantage plan covers the areas where you spend the most time. A limited area is unlikely to cause trouble if you rarely travel far from home. However, your plan won't cover you if you fall ill and require treatment further afield.

It's worth considering a different type of healthcare insurance if you go on vacation frequently or regularly visit family out of the area. 

What Are the Copayment and Co-Insurance Costs?

A copayment is a fixed dollar amount you pay for any covered healthcare services. Meanwhile, co-insurance is a percentage of your care costs that you must contribute for covered services, and many insurers cap the amount of coinsurance you pay. 

Understanding what you'll pay in copayments and co-insurance is essential before selecting a Medicare Advantage plan. Otherwise, you could find yourself faced with unaffordable costs if you require treatment. When choosing a plan that fits your financial circumstances, you'll need to balance the cost of monthly premiums vs. copayments and co-insurance. 

What Benefits Does the Plan Offer?

All Medicare Advantage plans must cover the same treatments and services as Original Medicare (Medicare Part A and Part B). Many Medicare Advantage plans may offer additional benefits, such as vision and dental care. Therefore, checking the Summary of Benefits is essential to understand what's included. 

The Summary of Benefits is based on the Evidence of Coverage (EOC) annual report. This report shows what services and treatments the insurer covered in the previous year and how much members paid for them out of pocket. All insurance agents selling Medicare Advantage plans must explain the Summary of Benefits to you, and it's worth checking that any services you expect to need are included. 

What Is the Plan's Rating?

Reading reviews and customer feedback for any plan you're considering is an excellent way to tell how the insurer performs. Therefore, it's a good idea to check the feedback on review sites and avoid companies with poor ratings and high numbers of unresolved complaints. High out-of-pocket costs, poor customer care and overly restrictive networks are all red flags to look out for. 

Fortunately, Medicare issues star ratings to help consumers choose a high-performing Medicare Advantage plan from an approved provider. These star ratings range from one to five, with five stars as the best possible score indicating excellent performance. 

What Is the Difference Between a Medicare Advantage Plan and Original Medicare?

The primary difference between Medicare Advantage and Original Medicare is that the latter is a type of federal health insurance. Meanwhile, you can only purchase a Medicare Advantage plan from a private provider. Medicare must approve any policies sold as Medicare Advantage plans by private insurers. 

Medicare Advantage plans cover the same services as Medicare Parts A and B but may cover additional services. Many plans include Part D coverage, which covers the costs of prescription drugs excluded by Original Medicare. 

The costs involved can also vary between Original Medicare and a Medicare Advantage plan. Original Medicare premiums depend on your income, and the same deductibles, copayments and coinsurance rates apply to all enrollees. Meanwhile, how much you'll pay in premiums and toward your treatment costs on a Medicare Advantage plan depends on your coverage and insurer. 

Why Should I Choose Medicare Advantage?

A Medicare Advantage plan can be a good option if you want more comprehensive cover than Original Medicare and don't have a serious pre-existing condition. These plans can help fill some gaps in regular Medicare coverage. 

However, a Medicare Advantage plan isn't the best option for everyone. You may be better off with a different type of healthcare insurance if you have specific health needs or network and area restrictions don't fit your lifestyle and preferences.