How to Choose the Medicare Advantage Plan That's Right for You - dummies

How to Choose the Medicare Advantage Plan That’s Right for You

By Patricia Barry

Copyright © 2015 AARP. All rights reserved.

Getting all your information in order really helps when you’re comparing Medicare Advantage plans. If you research plans by using Medicare’s online comparison tool, you can print out the details of the few that interest you. (Or you can ask someone else to perform this same search and send you the details.)

After you have this information, notice how the options become tons clearer when you write down the key details alongside each other. Feel free to use those tables as templates, or you can design your own. (For example, if physical fitness benefits such as gym memberships are important to you, note them down.)

But now you need to consider a question that isn’t answered on the plan finder but may be the game changer in picking one plan rather than another: Which doctors and hospitals accept the plans you’re considering?

Which providers accept the plans you’re considering

This point is really the $64,000 question, as they used to say on the old TV game show. If you prefer to continue seeing doctors you know, you won’t want insurance they don’t accept. On the other hand, if you’ve had difficulty finding doctors recently, you may welcome a plan that pretty much guarantees access to certain doctors even if you don’t know them personally.

Most Medicare Advantage plans — HMOs and PPOs — draw up contracts with doctors and other providers within a certain geographical service area for a period of one calendar year. So being in a plan may give you access to a larger pool of doctors willing to accept you as a patient. Or it may exclude you from doctors who don’t accept coverage from some specific plans or even from any plans in the Medicare Advantage program.

One way around this issue may be to choose a PPO that allows you to go to any doctor or hospital outside its provider network for a higher co-pay. But first check out how much extra you’d pay. In theory, Medicare Private Fee-for-Service plans also allow you to go to any provider, but doctors may accept this type of insurance on a visit-by-visit basis only.

So how can you find out which doctors and hospitals are contracted to the plans you’re considering, before signing up for one? The options are

  • Go to the overview section of any plan on the Medicare plan finder site and click on the “View physician and provider network website” link.

  • Call each plan and ask for its provider list to be mailed to you or for access to a website that lists its providers.

  • Call the offices of the primary care doctor, specialists, and hospitals you currently use and ask to speak to the person who handles insurance billing. Then ask whether that provider accepts the particular Medicare Advantage plans you’re considering.

Of the three, the third is the least time-consuming because, even armed with a provider list, you still need to confirm that those providers accept the plan.

Be aware, though, that Medicare Advantage plans are allowed to drop doctors from their provider lists during the plan year. If a plan does this, it must notify patients in writing at least 60 days in advance.

Enrolling in a Medicare Advantage plan

After you compare plans carefully and find out which ones work with the doctors and hospitals you want, it’s time to pick a plan. Only you can make this final decision, according to your own preferences and the information you’ve researched on each plan. If you get stuck, talking through the options with a counselor from your State Health Insurance Assistance Program (SHIP) may help to resolve the dilemma.

In contrast, actually enrolling in a plan is simple, with three options:

  • Click on the “Enroll” button next to the name of the plan of your choice on the plan finder program on Medicare’s website.

  • Call Medicare’s help line at 800-633-4227 (TTY 877-486-2048).

  • Sign up with the plan directly by going to its website or calling its customer service number.

If you’re new to Medicare, you can enroll in an MA plan during your initial enrollment period or, if you’ve delayed signing up for Part B beyond age 65, during the special enrollment period. Otherwise, you can sign up during any open enrollment (October 15 to December 7).

Taking action if you change your mind

After you enroll in a Medicare Advantage health plan, what happens if you discover you don’t like it? Of course, you have the right to change to any other MA plan, or to traditional Medicare, every year during open enrollment (October 15 to December 7). Outside that time frame, Medicare allows you to switch only for several specific reasons. However, here are several escape clauses:

  • If you want to drop out of an MA plan and change to traditional Medicare: You can use the annual disenrollment period that runs from January 1 to February 14 each year, regardless of whether you’ve just joined an MA plan or have been in one for several years. You can also switch to a stand-alone Part D drug plan at this time.

  • If you joined an MA plan as soon as you enrolled in Medicare at age 65: Medicare considers this first year a trial period. So you have the right to disenroll from the plan at any time within 12 months of first receiving coverage from it to switch to traditional Medicare and a stand-alone Part D drug plan. You also have the right to buy a Medigap policy within 63 days of your MA plan coverage’s ending.

  • If this enrollment is your first time in an MA plan and you dropped a Medigap policy to join it: You have the right to return to traditional Medicare and be reinstated in Medigap at any time during your first 12 months in the plan.

  • If you receive Extra Help: You can change to another MA health plan, or to traditional Medicare and a stand-alone Part D drug plan, at any time of the year.

  • If you move outside your plan’s service area: You can disenroll from the plan and sign up with another, or switch to traditional Medicare and a stand-alone Part D drug plan, in your new area when you move. In these circumstances, you also have the right to buy a Medigap policy with full federal protections, if you do so no later than 63 days after coverage from your MA plan ends.

  • If you enter or leave an institution, such as a skilled nursing facility or a long-term care hospital: You can change to another MA plan, or to traditional Medicare and a stand-alone Part D drug plan, at any time while living there or within two months of leaving.

  • If you live in a nursing home as a long-term care resident: You can change to a different MA plan, or to traditional Medicare and a stand-alone Part D drug plan, at any time of the year.

  • If an MA plan that has earned Medicare’s top five-star quality rating is offered in your area: You can switch to that plan at any time of year.

  • If you joined a Medicare Cost plan: You have the right to disenroll from it and switch to traditional Medicare at any time. If you received drug coverage from this plan, you can also switch to a stand-alone Part D drug plan at the same time.