6 Simple Ways to Tell If Medicare Advantage Is Right For You

Medicare Advantage (MA) was not a popular choice in Decatur, IL in years past, because there weren't very many choices. However, this alternative to the Original Medicare program has grown substantially in the past couple of years.

In 2019, there were only 4 MA plans in Decatur. In 2024, we have 32 plan choices.

With the growing number of options and more competitive plans, you may wonder: could it be right for me? Here are 6 simple ways to tell if a Medicare Advantage plan is going to fit your needs and budget.

Disclaimer: We do not offer every plan available in your area. Currently we represent 4 organizations which offer 41 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program to get information on all of your options.

1. What’s your budget?

When it comes to Medicare Advantage, most of the time, you’re looking at a very low premium. In fact, 20 of the MA plans in Decatur have $0 premium (in 2024).

The flip side is that you’ll likely have out-of-pocket costs nearly every time you use the plan. For example, you’ll pay $15 for every doctor visit, $45 to see a specialist, $250 for outpatient surgery, $265 per day for inpatient hospital care, and $265 for an ambulance (these numbers will vary depending on the plan).

Many think about Medicare Advantage plans as “pay as you go” plans.

If you have a $0 premium and you’re healthy as a horse, you’re looking at around $30 per year to see your doctor semi-annually for a basic checkup. If that sounds like you, you may benefit financially from an MA plan, but be sure to read the rest of this article for the rest of the considerations.

2. Do you travel?

If you’re a snowbird, an HMO Medicare Advantage plan is not for you. A Medicare Advantage plan is going to have a list of in-network providers and hospitals, and they’re generally within a radius of your zip code.

If you do travel out of your area, or even out of state, you’ll be subject to out-of-network costs, which can be very expensive.

It’s very common for out-of-network services to have a 50% coinsurance, which means you could be footing half of the bill for everything from a doctor visit to an overnight hospital stay.

Some plans won’t offer any coverage for out-of-network services, which means you’d essentially be going without insurance entirely.

This is a huge factor when considering if Medicare Advantage is right for you. If you do travel, it’s best to look at PPO plans with a nationwide network or consider a Medicare Supplement, which does not have provider or hospital networks.

3. Do you take prescriptions?

Medicare Advantage plans can be problematic when it comes to prescription drug coverage. The plans that do come with prescription benefits are actually called MAPDs, or Medicare Advantage Prescription Drug plans.

The particular prescription drug benefits that come with the plan may or may not be in your best interest, but you’re stuck with it and cannot choose a different drug plan.

The biggest consideration when looking at a drug plan is the formulary. First of all, are your drugs covered? Secondly, if they are, what tier are they in? Lower tier drugs may only have a $2 copay, while higher tier drugs may have a $100 copay.

If the planets align and the Medicare Advantage plan you want does cater to the drugs you take, it can work out well. If all you take is common generic drugs, you likely won’t have any issues.

However, there are also Medicare Advantage plans that do not come with prescription drug coverage, and in those cases, you are not allowed to purchase a Part D drug plan. If you do enroll in a Part D plan, it would automatically disenroll you from your Medicare Advantage plan.

The only time an MA plan without drug coverage makes sense is if you’re getting drug coverage from another source.

You are allowed to choose your own Part D drug plan if you have a Medicare Supplement. That Part D plan can be catered to your exact prescriptions, which allows you to save as much money as possible.

4. Do you want to keep your current doctor?

We mentioned earlier that if you travel, a Medicare Advantage plan may not be for you. That’s because of the network restrictions.

However, even if you plan to stay in your area, only certain doctors, hospitals, and pharmacies are going to be in the plan’s network.

You need to look at an MA plan's network and verify that your current doctors and hospital are in the plan's network.

If not, and if you want to keep your current doctor, you will pay more to see that out-of-network provider.

In this scenario, it generally makes more sense to look at Medicare Supplements, which do not have restrictive networks.

5. Are you interested in “extras”?

One of the big draws to Medicare Advantage plans are the extras that often come with the plan, such as:

• No-cost annual vision exam
• Eyewear allowance
• No-cost routine dental exams
• No-cost hearing exams
• No-cost gym membership or fitness benefits
• Allowance for over the counter drugs and supplies
• Flex cards
• Nurse hotline

If these extras are important to you, it may be worthwhile to take a look at a Medicare Advantage plan.

If a Medicare Supplement is a better fit for you, you can still purchase Dental, Vision, and Hearing insurance to cover the costs of exams and more.

6. What’s your risk profile?

While insurance isn’t all about the price, it’s probably one of the most important factors.

Since Medicare Advantage plans are pay-as-you-go plans, it’s important to understand how comfortable you are with the risk of paying thousands of dollars out of pocket. If a major medical event happened, you would be paying quite a bit out of your pocket.

With a Medicare Supplement Plan G, for instance, you’re paying the same monthly premium each month, and your only other expense is the Part B deductible, which is $240 in 2024.

Many are more comfortable with the predictability of a Medicare Supplement, while others want to take the gamble of a Medicare Advantage plan. If you are very healthy and are comfortable with the potential risk of out-of-pocket costs, an MA plan may be right for you.

In any case, risk profile is one of the most important factors to consider if you want to look into Medicare Advantage plans.

What’s right for you?

At this point, you might have a clear understanding of whether or not a Medicare Advantage plan is right for you. If you’re interested, don’t hesitate to give us a call at 217-423-8000.

If you’re still unsure and want to consult with an agent, that’s what we are here for! Please give us a call or schedule an appointment using our online system!

Finally, if you think you’re better suited for a Medicare Supplement, we can help with that, too.

Don’t wait to reach out to us – we love helping people save time, money, and hassle.

Other articles you may like:

• How Can Medicare Advantage Plans Have $0 Monthly Premiums?
• Learn More About Medicare Supplements In Illinois