Medicare Advantage Plans: Are They for You?

Medicare CardHemera/Thinkstock
One in four. That’s the number of Medicare beneficiaries—nearly 13 million in all—who get their health insurance (and often, a few perks!) from private Medicare Advantage health plans. The Centers for Medicare and Medicaid Services has estimated that compared to Original Medicare alone, an Advantage plan could cut your out-of-pocket health expenses by about $100 a month or $1,200 a year.

That’s impressive—but does it mean you should sign up? If you’re among the one in 10 Medicare beneficiaries whose only health insurance is Original Medicare—or if you’ve got supplemental insurance through a retiree plan or a Medigap policy—you may be wondering if you need this kind of “advantage.”

And if you already have an Advantage plan (also called Medicare Part C), you may be wondering whether your particular plan is still the best one for you. And even if you’re perfectly happy with your current Advantage plan, all those advertisements arriving in your mailbox for other Advantage plans may make you curious about your options.

“Everyone’s situation is different,” says Fred Riccardi, Director of Programs and Outreach at the Medicare Rights Center in New York City. “There’s no one right answer. You have to look at your health needs, your budget, and how well your current Medicare coverage is working for you.”

4 Ways to Find the Best Plan for You

Step 1: Gather your tools.
Get together this year’s medical bills (including premiums, co-pays, coinsurance and other costs) plus the containers of all the prescription drugs you take regularly. Get out a pencil or two, some paper, a calculator—and a computer with Internet access. These days, the quickest, easiest, and most hassle-free way to check your plan’s costs and coverage for next year and to compare it with others is via the U.S. government’s consumer Medicare website.

Step 2: Add up your medical expenses for 2012.
Include premiums, co-pays for drugs, coinsurance for doctor’s visits and treatments, and any other expenses that were applied to your deductibles. This is the first test of your plan. Were your expenses in line with what you expected to pay this year? Or did you pay more? If so, sleuth for the reasons. Perhaps you’re taking drugs with higher co-pays, or can’t get to a participating pharmacy because they’re too far away making your drugs cost more than they would at an in-network drugstore. Perhaps you chose a plan with low premiums and a high deductible, then had more out-of-pocket medical expenses than you expected. Maybe you had to see specialists who aren’t in your plan. Or perhaps you’re lucky enough to be quite healthy, and paid higher premiums for more coverage than you actually used.

Ask yourself if your health care was truly affordable this year. Could you buy the medications your doctor prescribed for you? Did you have problems covering co-pays or coinsurance amounts? Did you skip medications or doctor visits because they cost too much, or did you skimp in other areas (like food or heat) to pay medical bills? These are all signs you probably need a different plan—or may even be eligible for extra assistance.

Step 3: Consider your expected health needs for next year.
You can’t predict the future, of course. But you can make a pretty fair guess about your health needs in 2013 by looking at the drugs you take, the number of doctor visits (and types of doctors) you saw this year, and the medical supplies and treatments you use regularly. Also factor in any tests, medications, procedures, and treatments your doctor has told you you’ll probably need next year. You’ll need this information in the next step.

Step 4: Log onto
The U.S. government’s official Medicare website is the most reliable source of information on all Medicare Advantage and Medicare Prescription Drug Plans available in your area. You can narrow your choices by checking which plans your doctor uses, which cover the drugs you use regularly at the best prices, and which will have the lowest estimated out-of-pocket expenses. Need a little help? See Enrollment Made Easy.

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2 thoughts on “Medicare Advantage Plans: Are They for You?

  1. After checking with several of my medical providers, I have found that the majority of them do not accept the advantage plan so that I would have to change doctors in order to realize any benefit from one of these plans.  I value the relationship with my doctors of many years more than a few dollars per month.  No thanks.

  2. After checking with several of my medical providers, I have found that the majority of them do not accept the advantage plan so that I would have to change doctors in order to realize any benefit from one of these plans.  I value the relationship with my doctors of many years more than a few dollars per month.  No thanks.

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