Key Takeaways
- You have the option to modify your current coverage or sign up for a new plan during the Medicare Annual Enrollment Period (October 15 through December 7). Any coverage modifications take effect on January 1.
- Private health plans known as Medicare Advantage (MA) plans give additional coverages over and above what Original Medicare offers.
- To make an informed enrollment decision for 2023, this checklist contains important criteria to take into account when examining Medicare Advantage plans.
The Medicare Annual Enrollment Period (AEP), which begins on October 15 and ends on December 7, is open for enrollment. It’s time to decide on your healthcare alternatives for 2023 whether you or a loved one is a Medicare beneficiary or is approaching retirement age. This includes determining whether you want to modify your current plan or sign up for a Medicare Advantage (MA) plan for the first time.
What is Medicare Advantage?
One of Medicare’s four portions is Medicare Advantage, usually known as Part C:
- Medicare Part A – Hospital Insurance
- Medicare Part B – Medical Insurance
- Medicare Part C – Medicare Advantage (combines Parts A and B)
- Medicare Part D – Prescription Drug Coverage
Private health insurance companies called Medicare Advantage plans to have agreements with Medicare. Your Medicare-covered medical services are provided through the private plan if you choose to enroll in an MA plan.
You must be enrolled in Original Medicare to sign up for a Medicare Advantage plan (Parts A & B). This is also accurate if you wish to sign up for Medicare Part D drug coverage.
What does Medicare Advantage cover? Why do I need it?
Original Medicare covers part of the costs of services like doctor visits, durable medical equipment, labs, and hospital and skilled nursing facility stays (Part A) (Part B). However, it doesn’t cover all expenses. While MA plans include Original Medicare’s essential coverages, they also give additional benefits that can assist you in achieving and maintaining your health and wellness objectives. These may consist of:
- Routine dental care, hearing aids, and vision (eyewear)
- Memberships in health clubs
- Coverage for prescription drugs
Even more non-medical perks like meal delivery services and dietary counseling are sometimes included in Medicare Advantage plans. These programs are intended to encourage an active way of life where you have a sense of community.
How do I choose the best Medicare Advantage plan for me?
No Medicare Advantage plan works for everyone. Therefore, it makes sense to complete your homework first. Use this checklist to help you comprehend your options and choose a health plan after doing your research.
2023 Medicare Advantage Checklist
1. Are your favorite doctors, hospitals, and pharmacies in the plan’s network?
Make sure your favorite providers are included in the listings of in-network physicians provided by Medicare Advantage programs.
2. Does your plan allow you to visit a non-network provider?
Some plans allow you to visit doctors who are not in their network, but the out-of-pocket costs for these visits will probably be higher.
3. Are there prescription drugs you take regularly and does your plan cover them?
Prescription drug coverage (Part D) and Original Medicare benefits are both included in Medicare Advantage plans. Discover whether the precise prescription medications you take are covered by the plan you’re thinking about, as well as the cost. For instance, certain drugs are available with $0 copays under some MA prescription drug plans (depending on their drug list and drug-tier levels).
You should check each year to see if your prescription medications are still covered by your plan and how much you will have to pay for them because drug lists can change every year.
4. Do you enjoy being active and exercising? Would a fitness benefit interest you?
Many MA plans offer fitness programs for senior citizens like SilverSneakers® in addition to additional benefits like dental, vision, and hearing. You can use these programs to encourage physical activity in your daily life.
5. How much does your plan cost, and does it fit your budget?
Medicare Advantage out-of-pocket (OOP) costs are influenced by several variables, including premiums, deductibles, copayments, and coinsurance. Depending on the plan you select, these charges can change. The frequency of your medical needs and whether you see any specialists in addition to your primary care physician will also affect your costs. The amount you must pay out of pocket each year is capped under MA plans. Medicare Part C plans’ out-of-pocket maximum for 2023 is $8,300. (but some plans set lower limits).
6. Are there programs available to help you with Medicare out-of-pocket costs?
Medicare is not free, although it can help with some medical and healthcare expenses. If you require assistance with paying Medicare out-of-pocket expenses, look up the income requirements for various assistance programs and submit an application if you believe you may be eligible.
A Medicare Special Needs Plan (SNP), a kind of MA plan, can be an option for you if you have unique medical needs. Some people can participate in a Dual-Eligible SNP if they are Medicare and Medicaid eligible (D-SNP). Either elderly folks with limited incomes, people with disabilities, or those with end-stage renal disease qualify.
🔲 7. Would non-traditional benefits, such as transportation and food delivery services, be helpful to you?
Other non-medical advantages provided by certain Medicare Advantage programs include:
- Aid with utility expenses
- Having access to and getting help purchasing wholesome foods
- A credit for nonprescription products
- Assistance for preventing falls
- Companionship
Finding MA plans that contain these services may be a smart option if they would make your life easier.
Medicare Advantage enrollment and next steps
When selecting a Medicare Advantage plan, there are numerous things to take into account.
You’ll be able to choose the plan that works well for your medical requirements, lifestyle, and financial situation by doing some preliminary research.
Once you’ve found the MA plan that best suits your requirements, it’s time to enroll and pay your first premium. Keep in mind that there are only certain times when you can join (and leave) a private Medicare Advantage health plan. By keeping track of the times the registration window is available, you can avoid paying a late penalty cost.
Together with Aetna, this material was created. Learn more about Medicare and the information you need to know.
