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Things to Consider When Choosing a Medicare Advantage Plan

Things to Consider When Choosing a Medicare Advantage Plan

Enrollment in Medicare Advantage plans continues to grow. As a consumer, that means more choices when shopping to pick the plan that best fits your needs.

Medicare insurance choices are often made based on which plan offers the lowest monthly premium. A better yardstick for comparison shopping may be the overall annual costs. Because every person has different circumstances and unique health concerns, it is important to consider your own unique circumstances and health insurance needs when selecting a plan.

There are a few things to consider about how Medicare Advantage plans work and how they are different from each other.

Hospitals, doctors, other service providers and equipment suppliers

Many people feel strongly about being able to see their family doctor, and being able to visit their favorite local hospital. So, when it's time to compare Medicare Advantage plans , you may want to find out which doctors and hospitals are in a plan's network. Beyond that, you may also want to ask:

  • Can I see a doctor outside the network or list of preferred providers? If I do that, will I pay more?
  • Will I need a referral to see a specialist?
  • Which skilled nursing facilities and home health services are in the plan's network?
  • What happens if I travel frequently or live in a different part of the country during summer or winter months?


Prescription drugs and pharmacies

Most Medicare Advantage plans now include prescription drug coverage, however, there are exceptions. When choosing a plan, it is important to confirm that prescription drug coverage is included. The next thing to consider is whether the medications you take are on the list of drugs the plan covers. (This is called a formulary).

Other questions to ask are:

  • Can I use my pharmacy? Can I get my medications by mail order?
  • Will my prescriptions need "prior authorization" by the plan before I can get them?
  • Are there limits, such as being required to use a generic drug first before a more expensive drug will be covered by the plan?

You should also ask for an explanation of how the plan's generic and Anthem drugs' coverage tiers work.

Extra benefits and services not usually covered by Medicare

Medicare Advantage plans are required to offer the preventive services and other Medicare-covered services. Medicare-covered services are those that an enrollee would get if he or she has Original Medicare administered by the federal program. Beyond these covered services, some Medicare Advantage plans offer extra benefits. Some plans charge a little extra for these, while others do not. More questions you should ask:

  • Are there extra benefits for eye exams, new glasses, hearing aids, and/or dental care?
  • How much extra will I pay for these benefits?


Choosing a Medicare Advantage plan is a very personal decision. The tips and suggestions provided above give those who are eligible a good place to start as they shop for a Medicare Advantage plan.

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