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How do I choose a Medicare Advantage Plan? | Kentucky Health Solutions

How do I choose a Medicare Advantage Plan?

September 26, 2022 Pete Alberti Comments Off

It’s important to choose a Medicare Advantage Plan that fits your unique needs. Even if your friend or family member loves their Medicare Advantage Plan, it might not work well for you. There are numerous questions you can ask about a plan to determine if it would be a good fit for you, and you can find those below.

You can ask yourself the following questions before choosing a Medicare Advantage Plan:

  • How much are the premium, deductible, and coinsurance/copay amounts?
  • What is the annual maximum out-of-pocket cost for the plan? This amount may be high but can help protect you if you have expensive health care costs.
  • What service area does the plan cover?
  • Are my doctors and hospitals in the plan’s network?
  • What are the rules I have to follow to access health care services and my drugs?
  • Does the plan cover additional health care benefits that are not covered by Original Medicare?
  • How will this plan affect any additional coverage I may have?
  • What is the plan’s star rating?

Medicare Advantage Plans usually include prescription drug coverage. You should also consider these questions when choosing a Medicare Advantage Plan to make sure that the prescription drug coverage that the plan offers meets your needs:

  • Does the plan cover all the medications I take?
  • Does the plan have restrictions on my drugs (i.e. prior authorization, step therapy, or quantity limits?)
    • Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug.
    • Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one.
    • Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.
  • How much will I pay for monthly premiums and the annual deductible?
  • How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?
  • Is my pharmacy in the plan’s preferred network? You pay the least if you used preferred network pharmacies.
  • Can I fill my prescriptions by mail order?
  • If I have retiree coverage, will the Medicare drug plan work with this coverage?
  • What is the plan’s star rating?

Remember that Fall Open Enrollment runs from October 15 through December 7 each year. During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare coverage.

Let us Know if we can help you.

Sourced: Medicare Rights Center

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