What makes an Advantage plan “the Best”?

For example, for one client, having a plan that covers a particular medication may be the top priority. While, for another beneficiary, having a plan that has all their doctors in network is a must. I will briefly explain each of the factors that you must consider before joining an Advantage plan — and why they matter. For a more personal needs analysis, feel free to request a consultation.

The Basic Components

There are several components to every Medicare Advantage plan. Moreover, these are listed below in no particular order. The reason for this — each person has different needs and priorities. All of these components are important in choosing a plan, however, not everyone will need to put the same emphasis on each area. This is what allows for some plans to be better for some, and other plans for others.

Plan Type

• There are three main plan types as far as Advantage plans go. We have HMO’s, PPO’s and HMO-POS’s. Additionally, they all have different pros and cons. For instance, HMO’s generally have lower copays and higher benefit amounts but require you to stay in a certain network. On the other hand, PPO’s tend to have higher copays and lower benefit amounts, but give you the freedom to go in out of network. HMO-POS is a hybrid of the two, it allows you to get the benefits of an HMO, but have a bit more freedom on where you decide to get services. That freedom in HMO-POS comes from the POS (Point of Sale), the insurance carrier will pay any provider that accepts the terms of the plan.

Maximum Out of Pocket

• The Maximum-out-of-Pocket (MooP) is the most you can pay for covered medical services over the course of a year. Whenever you reach your MooP, the plan pays for all covered services at 100% for the remainder of the year. PPO plans tend to have a different MooP number for In-Network services and Combined (In and Out-of-Network) services. This allows for the ability to pay less by seeing in-network providers.

Medical Co-Pays

• The Medical Co-Pays or Co-Insurances dictate how much your provider will charge you for a visit. Although most plans have a $0 copay for Primary Care Physicians, if you see many specialists, you need to pay close attention to their copay amounts. Otherwise, you might end up paying a lot more than expected over the course of the year.

Network of Doctors

• The plan’s Network of Doctors is vitally important if you want to keep saying your same physicians without paying an enormous amount. HMO plans do not cover any visits out-of-network unless you are having a medical emergency. Although PPO plans do allow you to choose to go out of network for non-emergencies, they typically have a higher copay when you go out of network.

Prescription Formulary

• Although not all Medicare Advantage plans include prescription drug coverage, most do. And with very few exceptions, you are not allowed to get a stand-alone Part D plan if you are enrolled in a Medicare Advantage Plan. This means that if you opt for a MA plan without prescription coverage, you need to have either some other form of Rx coverage or risk being hit with a Late Enrollment Penalty (LEP). You can read more about the LEP in our Part D section.
• For those plans with RX coverage included, its vitally important to check the formulary, or list of covered medications, for everything you are being prescribed. If your Meds are not covered under the plan, it can be a lot of work to get them added to the formulary. We are still able to help, but its better to look into these things before signing up, rather than after.

Extra Benefits

• Extra Benefits can include anything from Dental to Grocery Cards to National Parks passes. Most Advantage plans include Dental, Vision, and Hearing coverage to some extent. Depending on your location, and other factors, such as having Medicaid — there are plans that will assist with monthly rent, utility bills, transportation and much much more. Although many of these “Extra Benefits” are available to everyone, there can be fine print. It’s ultra important to make sure you or your broker reviews the details on ALL extra benefits.

Medicare Star Rating

• Finally, we have the Medicare Star Rating. This is a compilation of ratings from Medicare Beneficiaries that have been in the plan over the past year. They rate each plan a certain number of stars based on all sorts of different criteria. Some examples include: Grievances (Complaints) Filed, Total Members joining or leaving a plan, Customer Service of the carrier, etc. Anything rated under 3 stars for more than 2 years is considered “Low Preforming.” This designation allows you to switch out of Low Preforming plans in the middle of the year. You also have a Special Enrollment Period once a year to join a 5 star plan, if they are any available in your area.

Summary

Each component of Medicare Advantage plans carries a certain amount of importance or weight. Although universally applicable, not each of these areas holds the same weight for each client. You can browse our Advantage plan selection by clicking here.

Scheduling a Medicare consultation with a broker you trust can eliminate the worry that you’ve missed out on a better plan option. Schedule a consultation today. Explain your needs to us, and we will take care of you. I promise that.