7 Reasons Why You May Benefit From a New Medicare Advantage Plan

Medicare's Open Enrollment is in full swing providing millions of seniors the chance to switch their coverage for the coming year. With the deadline to change rapidly approaching, here are 7 reasons you should investigate options now.

Reason 1: You are not satisfied with your plan's health providers

Medicare pays a fixed per-participant amount to the companies offering Medicare Advantage Plans. Companies must then use this to meet both their expenses and profit goals while, at the same time, follow rules set by Medicare.

In most cases, you will need to use health care providers who participate in the plan’s network. Some plans won’t cover services from providers outside the network and service area. Different rules regarding seeing a specialist are common. 

If you are satisfied with your current provider network, it is still smart to make certain they will remain available to you in 2022. If you are not satisfied, Open Enrollment is your chance to find a better choice for the coming year.

Reason 2: Your health care needs changed significantly during 2021

If you experienced a significant change in health, you may find your Medicare Advantage plan no longer is your best option. That can be especially true if you want to seek services outside your plan's network. For example, you may want to freely consult with multiple specialists or receive treatment from specialty providers such as the Mayo Clinic without pre-authorization.

 The easiest way to move from Medicare Advantage to Original Medicare is during Open Enrollment when anyone can leave Medicare Advantage with no questions asked. If you disenroll, the cancellation will take effect January 1.

Reason 3: Your premiums are higher than the average

The average 2022 Medicare Advantage (MA) monthly premium will be $19 according to the Centers for Medicare and Medicaid Services. That's actually a decline from $21.22-per-month, the 2021 average.

An analysis by the American Association for Medicare Supplement Insurance (AAMSI) found significant variance among available 2022 plans. For Texas the average MA monthly premium was $21. Plans costing as much as $72 and $85-per-month exist. In California, the average monthly premium was $20 while plans costing $51 and $58-per-month exist.

Reason 4: Your copayments or out-of-pocket costs are high

Depending on your particular Medicare Advantage plan you may pay a copayment for doctor or specialist visits, emergency room care, inpatient hospital stays and even prescription drugs.

Medicare Advantage plans also have out-of-pocket maximums that can vary from plan to plan. In 2021, the average out-of-pocket limit for Medicare Advantage enrollees was reported to be $5,091 for in-network services and $9,208 for both in-network and out-of-network services (PPO). However, the Medicare limits were $7,550 and $11,300 respectively. That means you risk being part of a plan that can assess you more than twice the average. 

Reason 5: Your drug deductible and plan cost is too high

Most Medicare Advantage plans today include Medicare Part D prescription drug coverage. Commonly referred to as MAPD plans, they offer all the coverage of original Medicare (parts A and B), and often include additional services. But that's where similarities often end.

For 2021, the average MAPD drug deductible was $192 (Texas) and $141 (California). But plans with maximum deductibles as high as $370 were to be found. You can shop around for the MAPD plan that best fits your needs. You'll need to enter all the medications you take in order to see drug prices for various plans.

Reason 6: The current plan did not receive a 4 or 5 star rating

Prior to Open Enrollment, Medicare surveys plan members and health care providers to give overall performance star ratings to Medicare Advantage plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. 

According to the AAMSI's Texas MA plan analysis, 1 in 4 plans were not rated 4 or 5 stars. For the 109 plans in California, only 44 received a 4 or 5 star rating. Experts will tell you that a plan's low star rating is an important reason to investigate better options for the coming year.

Reason 7: Your current plan doesn’t include new benefits

Medicare Advantage plans can offer a wide range of supplemental benefits including eyewear, hearing aids, preventive and comprehensive dental benefits, access to meals , fitness benefits and worldwide emergency/urgent coverage.

Some of these benefits are admittedly of nominal value but others can yield significant savings. Take dental benefits as an example. Some MA plans will limit the type of dental care coverage. Others offer a greater range of included care including periodontal and even implants. If you have a history of dental needs or anticipate some greater care needs for the coming year, this can be an important point of plan differentiation.

Finding The Best Medicare Advantage Plan Made Easy

For millions of seniors, December 7 is your chance to find the best Medicare Advantage plan for the coming year. The number of Medicare Advantage plans available varies greatly depending on where you live.

Those living in larger metropolitan areas typically have 30-to-40 plans to choose from. Those in less populous areas may have fewer than 20. Comparing all plans on your own however can be a daunting task. For that reason, many experts suggest reaching out to entities that offer comparisons of multiple plans.

A recommended option is speaking or meeting with an experienced local independent Medicare broker. A local agent will know area Medicare Advantage plans and often can also help compare available Medicare Supplement (Medigap) options. An excellent resource is the online Medicare agent directory hosted by the American Association for Medicare Supplement Insurance (AAMSI).

Nothing is more important than your health. Taking an hour between now and the end of Medicare Open Enrollment can be the best move to ensure a healthy year to come.