A 6-point checklist to rate your new Medicare Advantage plan

Published by Medicare Made Clear®

It’s a good idea for Medicare Advantage plan members to double-check their plan coverage before the Medicare Advantage Open Enrollment Period, which runs January 1 – March 31. Your new Medicare plan benefits go into effect on January 1, but even if you have the same plan as before, you’ll probably want to just be safe and re-review your plan since plans may change coverage and costs from year to year.

Here’s a quick checklist to rate your Medicare Advantage plan and make sure you’re getting the health services you want and need.

1. Support for your health and wellness

Medicare isn’t just for when you’re sick. You are also covered for many preventive services – flu shots, cancer screenings and an annual Wellness Visit, just to name a few. Some Medicare Advantage plans offer more benefits, like dental and vision coverage, fitness programs and even rides to medical appointments. Ask: Do you have the benefits you want with this plan?

2. Easy access to providers and services

You should be able to see your preferred doctors and get the care you need without a lot of hassle. Medicare Advantage plans generally have large local provider networks that include the doctors and main health care systems in their service areas. Ask: Can you go where you want to go for your health care?

3. Affordable coverage for the medications you take

Most Medicare Advantage plans include prescription drug coverage and have a list of covered drugs known as a formulary. It’s easy to miss whether your medications are on the list and then get a denial when you go in for a refill. Or you may have bigger copays than expected. Do: Double check that all your medications will be covered, and if not, work with your local pharmacist and your doctor to discuss covered alternatives.

 4. Clear explanation of coverage and benefits

Materials you receive from your plan have important information about your benefits, your rights, plan contact information and more. You may also get information on the plan web site or by calling the customer service number on the back of your plan member ID card. Ask: Do you understand your plan benefits? Do: If you have questions about your plan, take some time to talk with your provider until you feel clear and confident about your coverage. 

5. Help getting the care you need

It’s not always easy to know where to go for different medical needs or even when you should seek care. Do you make an appointment or go to urgent care? Can you treat a problem with a home remedy or an over-the-counter medication, or do you need medical help? Some Medicare Advantage plans provide a nurse line or care navigator to help you get the care you need and get the most out of your benefits. Ask: Does your plan have easy, accessible ways to help you get care?

6. Answers to your questions

Your Medicare plan’s job is to serve your health care needs. This includes helping you find answers to questions about coverage, costs, claims, bills and anything else related to your care. Customer service representatives, care coordinators, nurse line representatives and others provide help when you need it. Do you know who to call? Do: Identify and write down the appropriate contact names and numbers you need.

The Medicare Advantage Open Enrollment Period offers you a second chance to double check that your Medicare Advantage plan is truly the right fit for you. Take some time and make sure your health needs will be covered for this year, and if you find they won’t be, read this article on what you can do during this time.

Medicare Advantage Open Enrollment offers a chance to make a change if you find your new plan falls short of your needs.

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