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Medicare Advantage Checklist

Summary: Before enrolling in a Medicare Advantage plan, it’s important to consider a variety of factors. Our Medicare Advantage checklist can help you understand if Medicare Advantage is the right coverage for you. Estimated Read Time: 7 mins

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Table of Contents:

    1. What Should I Look for in a Medicare Advantage Plan?
    2. Check the Doctor Network of Your Medicare Advantage Plan
    3. Review Copayments and Coinsurance of Your Medicare Advantage Plan
    4. Understand Your Medicare Advantage Plan Benefits
    5. Consider the Coverage Area of Your Medicare Advantage Plan
    6. Review Medicare Advantage Plan Ratings
    7. Does Medicare Advantage Always Include Part D?
    8. How to Select a Medicare Advantage Plan

When you start to consider enrollment in a Medicare Advantage plan, it’s important to do your research into the plans available in your area and what they offer. Following a Medicare Advantage checklist can help you verify if a plan meets all your needs.

When enrolling in a Medicare Advantage plan, there are a few steps you should follow to ensure you enroll in a suitable plan for your needs. We have compiled a Medicare Advantage checklist to help you do just that.

Follow our Medicare Advantage enrollment checklist below to help you understand the differences in each available plan and what you should look for in healthcare coverage.

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 and may offer additional options to provide enrollees with more coverage. However, the plan you choose determines which benefits you do or do not receive and the cost of those benefits.

You will still have to pay a monthly premium, but 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
  • 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 is that Medicare Advantage plans 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.

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If the Medicare Advantage 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 could face with a Medicare Advantage plan. Before joining, make sure you understand the copayment or coinsurance amounts for your plan, as they may vary based on your chosen plan. 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 calendar year.

Your costs will be determined by several factors, such as how often you need medical services and how many specialists you would need to see. At the end of the day, you should choose the plan that makes the most sense for you and your budget.

Understand Your Medicare Advantage Plan Benefits

One of the most important items on this Medicare Advantage checklist is to understand the benefits included in your plan. Not all Medicare Advantage plans offer the same benefits, so it’s vital to check which plan has the benefits you need before you enroll.

Once you have a Medicare Advantage plan, it’s crucial to review your Explanation of Benefits (EOB) that your carrier will send you each month. The EOB is not a bill; it just states the medical services and items you’ve received that month and how much you may owe for them. It breaks down how much of the medical service or item costs will be covered by Medicare Advantage and how much you might pay out-of-pocket.

It’s also important to review your Medicare Advantage plan benefits each year with the Annual Notice of Change (ANOC). The ANOC is a yearly report that plan members receive from their carrier each September. The ANOC provides details about any upcoming changes to costs, coverage, and more that would be effective in January. Reviewing your ANOC in September can help you decide if you want to stay with your Medicare Advantage plan or carrier for another year.

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.

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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 Medicare 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.

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 may want to 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.

If your Medicare Advantage plan includes prescription drug coverage, it’s essential to ensure your preferred pharmacy accepts it. Also, check your plan’s formulary to see if your Medicare Advantage plan provides coverage for the prescriptions you need.

How to Select a Medicare Advantage Plan

Step 1 Decide if a Medicare Advantage plan is right for you

It’s essential to weigh all the pros and cons of Medicare Advantage over Original Medicare, to be sure that a Medicare Advantage plan will provide you with the healthcare you need.

Some factors to consider include availability, cost, network, and included benefits.

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Step 2 Research available Medicare Advantage plans

Once you’ve gone over the pros and cons of Medicare Advantage, it’s vital to do more due diligence. Research each Medicare Advantage plan carrier in your area. Compare insurance companies by looking into their premium rates, plan benefits, doctor network, drug formulary, customer and credit agency reviews, and if they offer any extra perks.

Step 3 Enroll in a Medicare Advantage plan

After you’re sure that a Medicare Advantage plan is right for you and you know which carrier you’d like to go with, the last step is to enroll in your chosen plan.

You can only sign up for Medicare Advantage during select periods. The first is your Initial Enrollment Period when you first become eligible for Medicare.

If you don’t sign up for Medicare Advantage during your Initial Enrollment Period, the next best time to enroll is during the Annual Enrollment Period. AEP happens from October 15 to December 7 each year.

If you already have a Medicare Advantage plan, you can switch to a different one or go back to Original Medicare during the Medicare Advantage Open Enrollment Period. The open enrollment period for Medicare Advantage is from January 1 to March 31 every year.

Get Help Choosing a Medicare Advantage Plan

We realize that finding the information you need about Medicare Advantage plans can be overwhelming. That’s why our licensed insurance agents are happy to help walk you through picking a Medicare Advantage plan that will suit you best. When selecting your healthcare, you want to make sure that your coverage meets your needs without depleting your savings.

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

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Understanding Medicare Advantage Plans. Accessed September 2023.
    https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare educator serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

2 thoughts on "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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