Know pros, cons of enrolling in Medicare Advantage

Know pros, cons of enrolling in Medicare Advantage

I am 72 years old and I have Original Medicare, a Medigap plan and a Part D plan. I am interested in a Medicare Advantage plan since it includes vision and dental benefits. What is a Medicare Advantage plan and, if I do not like the coverage, may I return to my current insurance?

Medicare Advantage plans are an alternative to Original Medicare. Original Medicare is the red/white/blue card that is familiar to many people; Original Medicare offers inpatient insurance (Part A) and medical insurance (Part B). Medicare Advantage plans are private companies that are contracted with Medicare to cover hospital and medical services in lieu of Original Medicare.

Medicare Advantage plans can offer additional services such as vision, hearing, and/or dental benefits. Most Medicare Advantage plans offer a Part D (prescription drug) benefit. While Medicare Advantage plans are an alternative to Original Medicare, people who elect Medicare Advantage must still be enrolled in Medicare Parts A and B.

Medicare Advantage plans must cover all the same services as Original Medicare (Parts A and B). However, Medicare Advantage plans are not considered supplemental coverage to Original Medicare. You will incur costs when using a Medicare Advantage plan. One of the costs involved is that most Medicare Advantage plans charge a monthly premium. Other costs involved are the co-payments that you must pay when you receive services.

To fully understand the costs of a Medicare Advantage plan, you must read the plan's summary of benefits. This document will outline your out-of-pocket requirements for medical/hospital services. Medicare states that each "Medicare Advantage plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities or suppliers that belong to the plan for non-emergency or non-urgent care)."

Many Advantage plans require you to use a network of providers. If you see a provider outside the network, you will have to pay more out-of-pocket (perhaps even the full amount charged by the doctor). You also must understand how your particular medicines are covered under the Medicare Advantage plan you are considering. You may call 1-800-MEDICARE or visit www.medicare.gov to perform a drug comparison to see how much you will pay for your medicines under a particular plan.

Medicare provides a one-time protection for a person (age 65 or older) to drop a Medigap plan to enroll into a Medicare Advantage plan and preserve their right to return to their Medigap plan. If you have never before enrolled into a Medicare Advantage plan, you may drop your Medigap to try a Medicare Advantage plan (this is called your "trial right"). If, within one year of enrolling into the Medicare Advantage plan, you decide you do not want to remain in it, you may return to Original Medicare.

You would have a 63-day window from the time to drop your Medicare Advantage to return to your Medigap plan. You would have the same 63-day window to elect a Part D drug plan. More information about the trial rights to a Medicare Advantage plan is covered on page 95 of the "Medicare and You" 2016 handbook and on page 23 of the Medicare publication, "Choosing a Medigap."

There are many important pieces to the puzzle when considering a Medicare Advantage plan. The most comprehensive way to analyze the coverage is to read the summary of benefits for any plan you are considering.

You may also visit www.medicare.gov or call 1-800-MEDICARE for guidance in your decision.

Amy Rubino is director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4464 or [email protected].

Covering

The Bases

Amy Rubino