Pre-Enrollment Medicare Advantage Checklist

When considering a Medicare Advantage plan, having a coverage checklist to verify the plan meets all your needs is crucial. We’re here with your pre-enrollment Advantage checklist so you can understand what you should be seeking in one of these plans.

What Should I Look for in a Medicare Advantage Plan?

If you’re looking for a Medicare Advantage plan, you’ll want to consider costs, coverage, and limitations. Sometimes known as replacement plans, these provide coverage in place of Part A and Part B.

You’ve probably 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 an Advantage plan.
Things you want to consider include:

  • Doctor Networks
  • Copayments and Coinsurances
  • Summary of Benefits
  • Coverage Area
  • Ratings and Reviews
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Why Do I Need to Check the Doctor Network with Medicare Advantage?

The first thing to consider on your checklist for Medicare Advantage plans is that they involve networks. These plans are most often HMOs or PPOs. When you visit a provider outside of your network, you end up paying out-of-pocket.

To avoid these costs, make sure your preferred providers are within the network of the Advantage plan you choose. Additionally, you’ll often need a referral from your primary care doctor to see a specialist.

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.

What are the Copayments and Coinsurance on Medicare Advantage?

Copayments are dollar amounts, while coinsurance is a percentage. Before joining, make sure you understand the copayments or coinsurance amounts for your plan. You’ll also want to know what the cap is on out-of-pocket costs.

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.

What Do I Look for in the Summary of Benefits?

A big part of any Medicare Advantage checklist is the Summary of Benefits, 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.

Why Should I Consider the Coverage Area?

Advantage plans won’t travel with you. In fact, the networks of some Advantage plans restrict members to doctors in their county. This usually isn’t a problem if you seldom travel, but it could be a burden if you travel often.

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, an Advantage plan might not be the best choice for you.

Medicare Advantage Plan Reviews and Ratings

While doing your research, it can be helpful to read reviews of Advantage plans. Reading about the experiences of other people who have had the coverage you’re considering can give you a better idea of how the plan works in practice. 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 Advantage and Part D plans so consumers can know if a plan is consistently low-performing.

How to Select a Medicare Advantage Plan

We hope this article helps you find some insight about what to look for in an Advantage plan. When selecting your health care, 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 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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