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Pre-Enrollment Medicare Advantage Checklist


When considering enrollment in a Medicare Advantage plan, following a checklist to verify the plan meets all your needs is essential for successful enrollment. Below, we outline our pre-enrollment Medicare Advantage checklist to help you understand the differences in each available plan and what you should look for in coverage.

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What Should I Look for in a Medicare Advantage Plan?

If you are exploring your Medicare Advantage options, you’ll want to consider costs, coverage, and limitations . Medicare Advantage plans combine Medicare Part A and Medicare Part B benefits with additional coverage options to provide enrollees with well-rounded coverage. However, the plan you choose determines which benefits you do or do not receive and the cost of those benefits.

You have likely even seen television commercials advertising zero-dollar premiums for Medicare Advantage plans. Well, the premiums aren’t the only cost you’ll have to deal with when you enroll in a Medicare Advantage plan. Medicare Advantage plans often come with out-of-pocket costs like copayments, coinsurance, deductibles, and more.

Things you want to consider when choosing a Medicare Advantage Plan include:

  • Doctor Networks
  • Copayments and Coinsurances
  • Summary of Benefits
  • Coverage Area
  • Ratings and Reviews
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Check the Doctor Network of Your Medicare Advantage Plan

The first thing to consider on your checklist for Medicare Advantage plans is that they involve networks. Medicare Advantage plans are most often HMOs or PPOs. Thus, you may or may not receive coverage outside of your network depending on the plan.

To avoid unnecessary costs, make sure your preferred providers are within the network of the Medicare Advantage plan you choose. Additionally, you should be prepared to need a referral from your primary care doctor if you wish to see a specialist. Medicare Advantage HMO plans require your primary doctor to submit a referral before you can see a specialist physician.

You’ll also want to find out if your prescription drug coverage works at your preferred pharmacies. If the plan doesn’t cover some or all of your preferred providers, find out if they offer out-of-network coverage. If not, you will likely need to change your doctors to utilize your coverage.

Review Copayments and Coinsurance of Your Medicare Advantage Plan

Copayments and coinsurance are some of the out-of-pocket costs you will face with a Medicare Advantage plan. Before joining, make sure you understand the copayments or coinsurance amounts for your plan and how that will impact your budget on a monthly basis. You’ll also want to understand your plan’s out-of-pocket maximum. This amount is the most you will pay out-of-pocket in a colander year.

The cost of each service from each plan varies. At the end of the day, you should choose the plan that makes the most sense for you and your lifestyle.

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Understand Your Medicare Advantage Plans Summary of Benefits

One of the most important items on this Medicare Advantage checklist is to understand the Summary of Benefits and perform a basic review of the Evidence of Coverage (EOC). The EOC is an annual report that plan members receive from their carrier each September. These documents provide details about costs, coverage, and more.

Your agent must go over important details with you from the Summary of Benefits for the plan you’re considering before enrolling. This way, you can make sure it provides the coverage you need. This will provide you with all of the information you need to know about your chosen plan.

Consider the Coverage Area of Your Medicare Advantage Plan

Medicare Advantage plans won’t travel with you except in the case of an emergency. So if you are on the go, these plans may not be right for you.

In fact, the networks of some Medicare Advantage plans restrict members to doctors in their county only. This usually isn’t a problem if you seldom travel, but it could be a burden if you require care out of town.

Make sure to think about how much you’ll be traveling in retirement and whether you’ll need to receive care when you’re away. If so, you may want to rethink a Medicare Advantage plan as coverage.

Review Medicare Advantage Plan Ratings

While doing your research, it can be helpful to read reviews and explore the ratings of specific Medicare Advantage plans. Reading about the experiences of other people who have used the coverage you’re considering can give you a better idea of how the plan works in real-world scenarios.

If you find frequent complaints about restrictive doctor networks, multiple mentions of the need for prior authorization, and tales of high out-of-pocket costs, you’ll probably want to steer clear of the plan in question.

Also, take into account the star ratings of the Advantage plan(s) you’re considering. Medicare uses this star rating system for Medicare Advantage and Part D plans so consumers can know if a plan is consistently high or low performing.

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Does Medicare Advantage Always Include Part D?

If you do not receive drug coverage from a creditable source and are enrolling in a Medicare Advantage plan, you’ll want to ensure you enroll in a Medicare Advantage Prescription Drug Plan. These plans include both health and drug benefits in one plan. Many but not all Medicare Advantage plans include prescription drug coverage.

How to Select a Medicare Advantage Plan

We hope this article helps you find some insight about what to look for in a Medicare Advantage plan. When selecting your healthcare, you want to make sure that your coverage meets your needs without depleting your savings. We also have an Original Medicare Enrollment Checklist.

We can help you find the best Medicare Advantage plans in your area. Call the phone number above to speak to an agent or fill out our online rates form today.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

2 thoughts on “Pre-Enrollment Medicare Advantage Checklist

  1. I am being bombarded by ads and cold calls for Medicare Advantage Plans and this is outside the annual enrollment period. Am I missing something? If enrollment is not possible, why all the calls?

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