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Medicare Advantage Isn't Just About Premium

Updated: Mar 15

Medicare Advantage plans are gaining popularity every year and one BIG reason they are so attractive are all the zeros! Many plans have $0 premium and $0 or low copays for most services. But before you get too excited, there are some things you should know.

  1. You may only enroll into plans available in your zip code.

  2. You must continue to pay your Medicare Part B premium, even if you join a $0 monthly plan.

  3. Be sure to understand the difference between an HMO and PPO plan. An HMO will require that you only see providers in the plans network, get referrals to specialists and there is only coverage for emergencies outside your plans service area. A PPO will allow you to see providers in network and out of network without referrals, however, your copays, coinsurance and max out of pocket will generally be much higher when accessing out of network providers.

  4. Medicare Advantage plans are tied to enrollment periods. Once enrolled you can generally only change plans at the annual election period or the Medicare Advantage Open Enrollment period or if you have a Special Election Period.

  5. Not every Medicare Advantage plan includes drug coverage, and if you go without creditable drug coverage for more than 63 days, Medicare can impose a late enrollment penalty when you enroll back into a plan with drug coverage.

  6. These plans do not require medical underwriting but if you dislike the plan and want to change to a Medicare Supplement, you will have to medically qualify unless you have a special guarantee issue situation.

  7. Not all plans include the same extra benefits you see on TV so be sure to fully understand the summary of benefits for each plan you are considering.

  8. Each plan can cover prescriptions differently so be sure to confirm your medications are covered and what your estimated costs will be before you sign up.

  9. Some plans are designed for people with special needs such as a chronic illness or Medicaid eligible so be sure to confirm any eligibility requirements before enrolling.

  10. Medicare Advantage plans change every year, so even if you are happy with your plan, you must always review your Annual Notice of Change in September for the following year so you are aware of any new benefit or cost changes.

These plans can be great but they are not for everyone so do your homework, ask the experts for guidance and remember, nothing is ever free.

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