Medicare Advantage plans are individual health care plans offered by private insurers that supplement your Original Medicare policy. They are required to include all of the benefits included in Original Medicare, and may include additional benefits, such as vision and dental care, prescription drug coverage, and more.
Premiums for Medicare Advantage plans (also known as Medicare Part C) can range from $0 to $200 or more, depending on your location and coverage. You’ll still pay a premium for Medicare Part B, which is typically $135.50 per month.
How to Find Plans
If you’re planning to enroll in Medicare Advantage, it’s important to find a plan that’s right for you. You may prefer to pay a high premium and have more comprehensive coverage, or a low premium and have higher out-of-pocket expenses. If you take any prescription drugs, you’ll need to make sure they’re included in the plan you sign up for.
You may also have to choose between an HMO plan or a PPO plan, which often have different policies around out-of-network providers. If you have a doctor that you want to keep seeing, make sure they’re in your plan’s network. If you plan to travel frequently and receive services in other states, find out if the plan that you choose will cover out-of-network services or charge more for them.
The Medicare website has a Plan Finder tool you can use to narrow down your options. You can either do a basic search by typing in your zip code and seeing what plans are available in your area, or you can do a more advanced search and look for policies that match your specific health care needs.
If you do a basic search, you’ll have to answer three questions: where you currently get your Medicare coverage, whether you get any benefits for prescription drug costs, and whether you currently take any drugs. If you do take drugs, you’ll have the option of adding them to your search so you can see more personalized search results.
Once you complete the search, you’ll be shown a summary of results, including:
- Prescription drug plans
- Medicare health plans with drug coverage
- Medicare health plans without drug coverage
For example, in the state of Nevada, there are 26 standalone prescription drug plans and 18 Medicare Advantage plans with drug coverage. Choose the category that you want to learn more about and you’ll be shown a chart that compares the premium, deductible, copay and other costs and benefits for each plan.
If you see a plan you like, you can click the “Enroll” button to sign up. You can only sign up during certain enrollment periods or when you first qualify for Medicare, but you can use the Plan Finder tool to research Medicare Advantage plans at any time.
Changes to Medicare Advantage Plans in 2019
Many people choose a Medicare Advantage plan when they first become eligible for Medicare at age 65. If you haven’t signed up yet, or want to change your plan, you’ll have to wait for an Open Enrollment Period. These typically run from October 15th through December 7th and from January 1st through March 31st each year.
You can also sign up during a Special Enrollment Period if you’ve recently moved, lost your employer-sponsored coverage, or meet some other qualifying circumstance.
You don’t need to reapply every year, but it’s a good idea to review your coverage and see whether your current plan is still a good fit for you. There are several reasons why you might want to change your plan, including:
- Your insurer has raised premiums or reduced your coverage
- Your health care provider is no longer in your network
- You’ve relocated to a new area that your insurer doesn’t cover
- Your current Medicare Advantage plan won’t be offered this year
- Your plan no longer covers the prescription drugs you take
You might also want to switch plans if you’ve had a change in your budget or health status and want to find a plan with a lower premium or different coverage.
As of 2019, Medicare Advantage plans will be allowed to offer more benefits, including preventive services, home health aides, meal delivery, adult day care, telehealth visits, rideshares to doctor’s appointments, and more. If you would benefit from any of these services, then it may be worth shopping around for a plan that offers them.
Quick Overviews of Plans
There are a lot of factors that go into choosing a Medicare Advantage plan, so let’s look at a few different plans to get an idea of your options. Remember, you can find plans that have premiums as low as $0, but you’ll want to look for hidden out-of-pocket costs.
At a minimum, all plans must include the benefits offered in Medicare Parts A & B. They also must have an out-of-pocket maximum of no more than $6,700 for in-network visits and $10,000 for out-of-network services. Some are significantly lower.
That’s better than Original Medicare, which doesn’t have an out-of-pocket maximum and could leave you footing the bill for long-term care and more expensive services.
Here are a few plans currently available in Nevada:
Aetna Medicare Choice Plan
Aetna Medicare Choice is a PPO plan that includes prescription drug coverage. It has a $0 premium and a $195 prescription drug deductible that you’ll have to meet before your drugs are covered. It has five different tiers of drugs, including Generic, Preferred Brand, and Speciality, so find out which tier your drugs are in before enrolling.
Preferred Generic drugs have a $0 copay, but Non-preferred drugs have a $100 copay, meaning your costs could vary significantly depending on which drugs you take.
For health care costs, you’ll have a $500 annual deductible and out-of-pocket maximum of $6,700. This plan includes vision and dental with a $0 copay, while doctor’s visits, lab visits, and mental health services have a $5-40 copay.
AARP MedicareComplete Plan
AARP MedicareComplete is an HMO plan that includes prescription drug coverage. It has a premium of $29 per month and no health care deductible. There’s a separate deductible of $290 for drugs and an out-of-pocket maximum of $4,900 for each.
This plan has five drug tiers with copays ranging from $0 for generic mail-order drugs to $300 for non-preferred drugs and 27% copay for specialty drugs. You’ll pay $10 to see a doctor and $45 to see a specialist. This plan does not cover vision and dental, although you can add comprehensive dental coverage for an additional $39 per month.
Senior Care Plus: Freedom Basic Plan
Senior Care Plus: Freedom Basic is a PPO plan with no prescription drug coverage. It has a $0 monthly premium and a $3,400 out-of-pocket maximum for in-network health care costs. You’ll pay $20 for doctors visits and $0-375 for diagnostic tests and lab services. Dental care is not covered, but vision is.
For medical equipment, including wheelchairs, oxygen, and prosthetics, you’ll pay 20% coinsurance. Wellness programs (including fitness) are covered with no copay.
Humana Gold Plus Plan
Humana Gold Plus is an HMO plan with a $0 premium and no deductible. It includes prescription drug coverage and has an out-of-pocket maximum of $1,500 per year.
Doctor’s visits have a $0 copay, including specialists, while there’s a copay of $120 for emergency room visits and $180 for an ambulance. Dental care is partially covered, with $0 copay for preventive treatment and 50% coinsurance for non-routine services.
Select Health Advantage Essential Plan
Select Health Advantage Essential is an HMO plan with no premium or deductible. It has an out-of-pocket spending limit of $1,700 per year, and includes prescription drugs at five different pricing levels. It has a $0 copay for preferred generic drugs and 33% copay for drugs in the specialty tier. You might pay up to 37% if you fall into the coverage gap.
You’ll pay $0 for doctor’s visits and for preventive dental care, and can choose to pay an additional $22 per month for comprehensive dental coverage.
As you can see, Medicare Advantage plans offer a range of coverage options. If you’re in good health but want vision or dental coverage, then you may choose a different plan than someone who needs medical supplies or hearing aids.
If you need prescription drug coverage, then you’ll want to make sure your specific drugs are included, and that you won’t fall into the coverage gap. If you travel often, you may prefer a PPO that has a low out-of-pocket maximum so you don’t find yourself restricted to your local HMO network or paying additional fees.
Use the Medicare Plan Finder to help you compare plans. You can also look for plans that are specific to diabetes, lung care, and other long-term health issues.
If you need additional help, reach out to the licensed insurance agents at the Medicare Store to schedule a free 15-minute phone call or a 30-minute in-person meeting at a location near you. They can even come to your home for a consultation.
Don’t wait until the Open Enrollment Period is upon you! Start comparing your options and find a Medicare Advantage plan that offers the coverage you need.