Things to Consider When Choosing or Changing Medicare Advantage Plans

When you become eligible for Medicare, and when you annually review your changing needs, you’ll want to consider these areas to determine if you have the right Medicare coverage, or if you should be looking for a new policy.

Your health

Your health is an important consideration in choosing or changing insurance plans.

• You may be in excellent health and want to focus on preventive screening together with health and fitness resources.
• You may have a chronic illness that results in frequent specialist visits, therapy and expensive medications.
• You might have experienced a recent diagnosis that will increase your healthcare needs.
• A thorough needs assessment can help you choose the right plan for your circumstances.

When considering changing your healthcare insurance, it is crucial to review your utilization of health care services. This will allow you to accurately compare the coverage and potential costs that would be affected by changing plans.

Coverage and costs

• Premiums, deductibles and other costs should be in line with what you can afford.
• What, if any, is the yearly limit on what you could pay out-of-pocket for medical services?
• Make sure you understand any coverage rules that may affect your costs.

Other coverage

• If you have other types of health insurance coverage, make sure you understand how that coverage works with Medicare. Talk to your benefits administrator.
• If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your plan administrator.
• If you have VA, or TRICARE for Life, contact us before making any changes.

Doctor and hospital choice

• If you have a close relationship with your doctor, you’ll want to be sure that s/he accepts the plan you want to enroll in.
• You will also want to be sure your hosptal and healthcare providers are in the network (if any) in the plan you want to enroll in.

Prescription drugs

Before deciding on a plan, you will want to:

• Determine whether the prescriptions you take are covered under the formulary of the plan.
• Examine the tier structure of the plan you are considering to better control the costs of your prescription drugs.
• Even if you take few or no prescription medications, you should sign up when you are first eligible to avoid paying a Late Enrollment Penalty.

Quality of care

The quality of care and services offered by plans and healthcare providers can vary.

We can help you compare plans and verify providers.

Convenience

• You’ll want to ensure that doctors and specialists you are likely to need are nearby.
• Which pharmacies can you use? Can you get your prescriptions by mail?
• You may pay less for some drugs at pharmacies that offer preferred cost sharing or that will fill prescriptions by mail (usually as 3-month orders).

Travel

Not all plans will cover you if you travel out-of-state or to other countries. If you’re a traveller, you will want to be sure that your plan covers you if you travel to another state or outside the U.S.*

Your Medicare Advantage Plan may, or may not, cover care outsid its service area. Some plans may cover providers that are out-of-network or out of your service area,** but with higher cost-sharing. Your plan may also impose other rules or restrictions. Contact your plan to see what rules and costs apply when you travel within the U.S.

A Medicare Advantage Plan may offer additional coverage for healthcare services you get outside the U.S. Check with your plan before travelling to see what is covered.

*The term “outside the U.S.” means anywhere other than the 50 states of the United States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands.

** Note: Medicare Advantage Plans are required to cover emergency and urgent care anywhere in the U.S. without imposing additional costs or coverage rules.

We know you have questions. Please Click here or call 941/704-6343 so a licensed agent can help you make the right decision about the policies that best suit your needs.

We do not offer every plan available in your area. Currently we represent nine organizations which offer 76 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.