California Medicare Advantage Plan

How to Choose a California Medicare Advantage Plan

Choosing the right type of Medicare coverage can feel a little like trying to find a needle in a haystack. While the different options available to you make it possible to get coverage that will most benefit you, it can be a bit challenging to sift through all of the options. Use these tips as a guide to help you choose a California Medicare Advantage Plan that will meet your needs.

Choosing a California Medicare Advantage Plan

Before you enroll in a California Medicare Advantage plan, you need to gather as much information about the options available to you as you can. Take some time to discuss the plan with people who are currently enrolled if possible, and be sure to discuss it with you doctor. Look for answers to some key questions, including:

Are your current/preferred physicians in the network of providers covered by the plan, particularly if you are considering enrolling in an HMO or a Preferred Provider Organization (PPO)?

If your physician is not in network with the plan you are considering, does he/she participate in a different one?

How much will your plan charge if you choose to see a physician outside of the network?

Does the MA plan include Part D drug benefits? (Keep in mind that several MA plans, including Private Fee-for-Service (PFFS) or HMO plans, do not.)

If the plan does include drug benefits, does it cover your current prescription medications?

Do you currently have California Medigap Plans? (If so, you will not need to keep it if you enroll in an MA plan.)

Know what is appropriate to discuss regarding your medical history.

Coverage with an MA plan may only be denied if you have end-stage renal disease (ESRD). However, representatives may question you regarding other health conditions to help your primary care doctor consider specifics regarding your care and services, as well as to ascertain your eligibility for certain programs provided by the MA plan for individuals with chronic conditions.

If you are considering switching to this type of coverage as a cost-savings measure, be sure your thoroughly understand the plan’s copayments and cost-sharing amounts for services. Depending on your health and coverage, some monthly premiums may be low; however, the charges for doctors’ visits and other services may be high.

Understand the difference between Medicare Advantage (MA) Plans and Medigap Policies.

There are many factors that determine whether and MA plan or a Medigap policy is the right type of coverage for you. Be sure to thoroughly consider the options available to you in your area that also meet your preferences and income.

MA plans provide coverage for services provided under Medicare Parts A and B, and several additional services that are not traditionally covered by fee-for-service Medicare. If you select an MA plan, you do not need a Medigap policy. In fact, it is actually illegal for a company to sell you a Medigap policy if you have an MA plan.

Once you become eligible for Part B, you are guaranteed the right to purchase a Medigap policy during the first 6 months of your eligibility (unless you are younger than 65 or have end-stage renal disease). If you MA plan changes, you may become eligible for Medigap.

Be aware of out-of-pocket costs

As a general rule of thumb, MA plan premiums are lower than Medigap policy premiums, yet the copayments of an MA plan my make it more expensive than a Medigap policy. This depends on the types of services as well as the benefits you use. Additionally, most MA plans require that you make a small copayment each time you visit your doctor or use other services. It’s important that you understand each of these costs before enrolling in an MA plan.

It’s also important that you are aware of the fact that some MA plans provide additional services to those covered by Medigap policies, such as vision and dental exams, prescription coverage, hearing aids, and even wellness classes. If you have original Medicare and a Medigap policy, you will also need to purchase separate coverage for Medicare Part D prescription drug benefits.

Understand your access to providers may change.

Certain MA plans, including HMOs, will only allow you to see health care professionals who are affiliated with the plan. This access is referred to as being in the network of providers covered by the plan. Conversely, most Medigap policies allow you to see any doctor you select.

While these steps can guide you through selecting coverage, it is important that you take your time and avoid feeling pressure to sign on with any plan. Your medical coverage is your choice, and you should be able to take the time to gather all the facts so that you feel comfortable making a decision.

Just be sure to keep accurate records as you discuss your options with different professionals and be sure to pay attention to any enrollment period deadlines that may apply. And once you have taken each of these factors into consideration, select the plan that provides the best coverage for you and your needs.