Choosing a Medicare Advantage Plan

Medicare Advantage Plans are an alternative form of Medicare benefits. You still have Medicare benefits, however by enrolling in a Medicare Advantage plan you are giving a private company permission to administer your Medicare benefits according to their rules. You are subject to the plan rules and cost sharing, not Medicare’s. Plans must provide the same services as Original Medicare.

It may help to print this page for reference.

To find Medicare Advantage Plans, you can use the Medicare Advantage Comparison tool from Medicare.gov. You should always compare Medicare Advantage Plans carefully before enrolling. Some important questions to ask yourself as you look at several plans include:

  • Insist on a simple outline of coverage. Know what you are buying and how it works. Is this an Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO) or a Private Fee-for-Servie Plan (PFFS)?
  • Are prescription drugs covered?
  • What will my premium be?
  • What will I have to pay when I go into a hospital?
  • What will I have to pay when I see my doctor?
  • Do I need to choose a primary care doctor?
  • Can I get my health care from any doctor or hospital?
  • Do I have to see a primary care doctor to get a referral to see a Specialist?
  • Do my providers (doctors, hospitals, etc.) accept the terms and conditions (payment) of this plan?
  • What will my other cost-sharing be?
  • Will this plan “travel” with me throughout the United States?
  • Can I return to Original Medicare at any time?
  • What else do I need to know about this type of plan?

Don’t feel pressured to enroll right away. Open enrollment is November 15th to December 31st. You may also change one more time from January 1st to March 31st, including going back to Original Medicare.

Do not drop current insurance coverage until you are sure about your new coverage. Do not join more than one Medicare Advantage Plan. Do not buy a Medigap policy if you already have a Medicare Advantage plan. They will not work together.

Never buy from someone who claims to be from the government. The government does not sell insurance. Keep information on the agent or representative that enrolls you for future reference.

Do not enroll in a Medicare Advantage plan if you have MO HealthNet (Medicaid). Currently, MO HealthNet will not pay your plan co-payments unless you are enrolled in QMB or QMB Plus. Otherwise, you will be responsible for the co-payments.

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Guidelines for Medicare Advantage Plans