Medicare Advantage plans offer a way to receive Original Medicare through a private health plan that may offer additional benefits.
Also sometimes called "Part C" or "MA Plans", they are offered by Medicare-approved private companies that must follow a certain set of rules.
The Medicare Rights Center helped us to develop this questionnaire for you to consider when choosing a Medicare Advantage plan through a private company.
Offered by private companies, most Medicare Advantage Plans offer insurance coverage for things that Original Medicare doesn't cover, like some vision, hearing, dental, and fitness programs. During the selection process, you'll want to see what benefits they offer, if you qualify, and if there are any limitations. These are some questions you can keep in mind when making a choice about how to receive your Medicare coverage, and whether a Medicare Advantage Plan is right for you.
Providers, hospitals, and other facilities
- Will I be able to use my doctors? Are they in the plan’s network?
- Do doctors and providers I want to see in the future take new patients who have this plan?
- If my providers aren’t in-network, will the plan still cover my visits?
- Which specialists, hospitals, home health agencies, and skilled nursing facilities are in the plan’s network?
Access to health care
- What is the service area for the plan?
- Do I have any coverage for care received outside the service area?
- Who can I choose as my Primary Care Provider (PCP)?
- Does my doctor need to get approval from the plan to order tests or admit me to a hospital?
- Do I need a referral from my PCP to see a specialist?
- Does the plan cover any services that Original Medicare does not?
- Are there any rules or restrictions I should be aware of when accessing these benefits?
- What costs should I expect for my coverage (premiums, deductibles, copayments)?
- What is the annual maximum out-of-pocket (MOOP) cost?
- How much will I have to pay out of pocket before coverage starts (what is the deductible)?
- How much is my copayment for services I regularly receive, such as PCP or specialist care?
- How much will I pay if I visit an out-of-network provider or facility?
- Are there higher copays for certain types of care, such as hospital stays or home health care? Can I afford the copays if I need the care over a long time period?
- Does the plan cover outpatient prescription drugs?
- Are my prescriptions on the plan’s formulary?
- Does the plan impose any coverage restrictions?
- What costs should I expect to pay for my drug coverage (premiums, deductibles, copayments)?
- How much will I have to pay for brandname drugs? How much for generic drugs?
- What will I pay for my drugs during the coverage gap?
- Will I be able to use my pharmacy? Can I get my drugs through mail order?
- Will the plan cover my prescriptions when I travel?
Coordination of benefits
- How does the plan work with my current coverage?
- If I join, would I lose my job-based insurance or retiree coverage?