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Is a Medicare Advantage plan right for you?

There are two ways you can receive your Medicare benefits: through original Medicare or through Medicare Advantage. Original Medicare consists of Parts A (hospital coverage) and B (medical coverage). Many people also enroll in a standalone Part D prescription drug coverage policy.

Medicare Advantage plans consist of parts A and B and often Part D. These plans are offered by private insurance companies approved by Medicare. Medicare Advantage plans are similar to the managed care plans you may already be familiar with through your employer. They’re often HMOs or PPOs: you will need to see providers in the plan’s network or pay a much higher copay or risk not being covered at all. Most of these are regional networks, so if you’re a snowbird who lives up north during the summer, you probably won’t have in-network options for your non-emergency healthcare. You will likely need referrals for specialized care and preapproval before certain treatments are covered. Some say that denials of coverage are more frequent than with original Medicare. However, through the careful management of care, a Medicare Advantage plan can often cost you less out-of-pocket and sometimes include coverage for dental, vision, and hearing, which original Medicare does not.

The AEP is one of the only times you have to change the way you receive your Medicare benefits. During this period, you have several options:

Choosing between Medicare and Medicare Advantage

• Change from original Medicare to a Medicare Advantage plan (also known as Medicare Part C)
• Change Medicare Advantage plans
• Switch from a Medicare Advantage plan to original Medicare
• Review and switch standalone Part D drug plans

If you’re happy with your current choice, you can stay with it as long as it is still being offered—just be sure to check if there are any changes that affect your coverage to the plan you’re currently enrolled in. You should have received an Annual Notice of Change listing any upcoming changes. Medicare Advantage plans and Medicare drug plans may change what they cover, their costs, and their provider networks from year to year.

Health care costs can eat up your retirement savings, so carefully consider your health and financial situation. Someone with a health history of chronic disease that requires expensive prescriptions will likely need a different plan than someone who sees his or her doctor once a year for a physical.

Questions to consider when choosing a plan during Annual Open Enrollment

• Have you received a new diagnosis or started taking a new medication?
• Did you change doctors?
• Can you afford the costs (copays, deductibles, etc.) that come with your current coverage?
• Does your prospective plan include your doctor in network?