Choosing a Medicare Advantage plan

How to make a decision that best suits your needs

The American population is aging. By 2040, the number of Americans aged 65 and older will reach approximately 80 million. 

Older adults are frequent targets of marketing efforts to encourage them to choose a Medicare Advantage plan. Medicare pays a fixed amount for your care each month to the companies offering these plans. 

These plans are sometimes called Part C or MA Plans and are offered by Medicare-approved private companies that follow rules set by Medicare (the federal government). Often, Medicare Advantage products include drug coverage or Part D plans. 

These plans advertise on TV, radio, and through direct mail to seniors. They market their coverage of gym membership, transportation, and additional vision, hearing, and dental care benefits while intentionally refraining from mentioning the drawbacks. 

Before you select a Medicare Advantage plan, research the plan in-depth, review potential plans with a trusted friend or family member, and/or discuss the plan with your primary care physician (PCP). It is essential to understand both the benefits and the drawbacks. 

One in four senior physicians with regular Medicare insurance already have a Medicare supplemental insurance or Medigap policy. Some Medicare Advantage plans restrict your ability to use Medigap insurance for cost-sharing. 

If you enroll in a Medicare Advantage plan and then decide to cancel your plan and return to regular Medicare, you cannot simply return to your previous Medicare plan. In fact, you may have difficulty securing a plan. Some plans also require you to provide medical information to qualify for coverage, and others are relatively expensive.

Tips:

1. Check the plan’s impact on your Medigap policy.
2. Ensure the plan has adequate coverage for routine care, chronic disease management, and emergency care.
3. Ask what are the out-of-pocket costs for drugs.
4. Ask what are the out-of-pocket costs for direct physician services and testing.
5. Ask what are the rules if you need to meet with a specialist. 
6. Ask if the plan requires a PCP to provide a referral prior to an appointment with a specialist.
7. Ask if, after electing to participate in a Medicare Advantage program, you are also eligible for a supplemental payment.
8. Ask if your current physician(s) is included in the Medicare Advantage network.
9. Understand the policy is subject to change each year.
10. Understand the out-of-pocket costs if you decide to opt-out of a Medicare Advantage plan.

For more information, visit www.medicare.gov/basics/get-started-with-medicare.

Dr. Dionne Hart specializes in psychiatry and addiction medicine. She was the inaugural chair of the American Medical Association’s Minority Affairs Section and the first Black woman elected to the Minnesota Medical Association’s Board of Trustees. She is a past Minnesota Psychiatrist of the Year. In 2020, the Minnesota Physician Journal named her one of the 100 most influential healthcare leaders in Minnesota. She is the president of the Minnesota Association of African American Physicians.