First, let’s define what a Medicare Advantage plan really is. Simply put, it is a private insurance plan, also known as Medicare Part C, for people eligible for Medicare. These plans are optional, however, to qualify, you must participate in Medicare Parts A and B. All best Medicare Advantage plans must meet the minimum standard benefits offered by Original Medicare (Parts A and B). In general, they offer additional benefits such as lower or fixed copayments, dental plans, eye exams and other services. These private insurance companies offer these plans as HMO or PPO plans.
In California, there are many carriers and each can offer several options. For example, in Los Angeles County, there are 32 different Medicare Advantage plans. However, in central or northern California, such as El Dorado County, there are less than five plans available. Some offer low cost or no cost options and others have a premium. So how do you know which one is best for you? Well, there is no perfect answer or plan for this, but we can narrow it down by observing a few things:
- Make sure your doctors are on the network
- See the Medication Form for your specific prescriptions.
- Plan ratings (what other members think)
Check co-payments and deductibles:
These are just a few things to consider and be sure to compare your options before signing up for a plan. Another factor to consider is your income. For those with low incomes and qualifying for Medi-Cal, the California Medicaid program has additional options that can also help keep your costs down. These Medicare plans are called Dual Eligible or are commonly referred to as “Medi-Medi” plans.
Each person has a unique situation and needs to be treated as such. Medicare Advantage plans are not one size fits all! It’s important to ensure that you get a plan that meets your needs and budget, as there are limited sign-up periods that restrict when you can make changes to your plan. For example, the most common is the annual open enrollment period from October 15 to December 7 of each year. This period is when you can sign up or make changes to your current Medicare Advantage plan for the upcoming calendar year. Once subscribed, there are just a few circumstances that will allow you to change mid-year.
Be sure to review your options carefully before making a decision about your Medicare Advantage coverage.