How to Determine if Your Medicare Advantage Plan Is Right for You

Victoria Burke by Victoria Burke | Licensed since 2011

This article was updated on: 10/04/2018

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Your Medicare Advantage plan, also known as Medicare Part C, coverage details could potentially change each year. That’s why it’s important for you to review your Part C plan options each year to ensure that you continue to be enrolled in the right plan for your needs. If you’re enrolled in a Medicare Advantage plan, you should evaluate your coverage options during the following times of the year:

  • In the fall during the Annual Election Period (October 15 to December 7)
  • At the beginning of the year during the Medicare Advantage Disenrollment Period (January 1 to February 14)

Evaluating your Medicare Advantage plan

Consider your costs

  • If your current Medicare Advantage plan has a low monthly premium and a high deductible, are you paying more out-of-pocket than you expected?
  • Is your health care affordable, or do you have trouble meeting your copayment or coinsurance amounts?
  • Are you able to afford your medications?

If you are having a tough time meeting your health care costs, you may want to compare your plan with other Medicare plan options, including other Medicare Advantage plans.

How about your health-care dollars? What are you spending the most on this year?

  • If you spend the most money on your prescriptions, consider looking for a plan that covers your medications at the lowest cost to you.
  • If you spend the most money on office visits to specialists, compare plans to find out which one has the lowest copayments for specialists.
  • If you are relatively healthy and spend the majority of your health care dollars on your monthly premiums, consider whether a plan with lower premium, but keep in mind that lower overall costs may mean a higher deductible.

All Medicare Advantage plans must limit the amount of money you pay yourself each year for covered services. This amount, also known as the Maximum Out-Of-Pocket (MOOP), may potentially change each year. No plan can ask you to pay more in a calendar year. Keep in mind that plans can set a lower limit, so you may want to consider a plan with a lower MOOP limit.

Consider your access to care

Has anything changed recently in how you receive your Medicare services? For example:

  • Did your doctor stop accepting your plan?
  • Did your specialist retire?
  • Have you received a diagnosis that requires care by a specialist, but your plan doesn’t offer enough choices for in-network providers in your area?

If your Medicare Advantage plan makes it difficult to get the Medicare services you need, you may want to compare plans to see which plan offers the most choices for health care providers in your area.

Deciding what to do next

If your Medicare Advantage plan no longer meets your needs:

If you decide your Medicare Advantage plan no longer meets your health or budget needs, you can make changes during the Medicare Advantage Disenrollment Period or the Annual Election Period.

You can leave your plan from January 1 through February 14

  • This period is called the Medicare Advantage Disenrollment Period (MADP).
  • During this time, you may leave your Medicare Advantage plan and go back to Original Medicare (Part A and Part B).
  • If you were previously enrolled in an MA plan with drug coverage and return to Original Medicare, you can then enroll in a Medicare Prescription Drug Plan (PDP) during this time.
  • Your new coverage would take effect on the first day of the month after you enroll.
  • You cannot switch plans or join a Medicare Advantage plan during this time.

You can join, switch, or leave any plan from October 15 through December 7

  • This period is called the Annual Election Period (AEP), or Annual Enrollment Period.
  • During this time, you can join, switch, or leave any Medicare Advantage plan available to you.
  • You can also return to Original Medicare and make any changes to your Medicare Part D coverage.
  • Your new Medicare coverage will take effect on January 1 of the following year.


If your Medicare Advantage Plan still meets your needs

If you are happy with your current Medicare Advantage plan, you do not have to worry about doing anything. Unless your plan leaves your service area or stops contracting with Medicare, you can stay with the plan you know and trust.

However, keep in mind that plan offerings and costs may change each year. To make sure your Medicare Advantage plan will continue to meet your needs, you should review your plan and compare it to all other types of Medicare coverage options every fall, and again at the beginning of the year. By comparing your coverage options, you can ensure you continue to receive the Medicare services you need at a price that is right for you.

If you take anything away from this article, it’s that you should review your existing Medicare coverage each year. Don’t think that you have to stay in a plan that’s no longer meeting your needs just because you’re enrolled in it. If you feel that way, or have any other questions about other private Medicare plans that could potentially serve you better, then don’t hesitate to contact me. To learn more about me, go ahead and click the orange button underneath my photo below to check out my profile. We can talk about your options or I can email you personalized information through the other two links down there. If you’d rather compare plan options on your own to start, you can definitely do that too. Just scroll back up and hit the blue Find Your Plan button on the right side of this page and view the plans offered by insurance companies in your area.

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