Whether you're enrolling in a Medicare Advantage plan for the first time, switching your current coverage, or renewing your current coverage, it's important to know what to review before choosing a plan. In this video, we're going to go over our pre-enrollment Medicare Advantage checklist so that you can feel more confident in your decision.
Your pre-enrollment Medicare Advantage checklist will include: • Which doctors are in your plan's network • Your plan's coverage area • Cost-sharing • Summary of benefits • Drug formulary (if the plan includes prescription drug coverage)
The first item on the checklist is doctor networks: • Most Advantage plans are HMOs or PPOs with limited networks so it's important to make sure that all of your physicians are within the plan's network • If you have multiple doctors, make sure each one accepts the plan you're choosing • Also, consider that you'll need a referral from your primary care physician to see a specialist
The next item on the checklist is the coverage area: • Advantage plans do not travel with you – thus, if you travel a lot, an Advantage plan might not be the best option for you because some restrict you to the doctors within your county
Next up is cost-sharing/out-of-pocket costs: • Cost-sharing varies from plan to plan • It includes deductibles, coinsurance, and copays • Check how much copays are to see primary care physicians and specialists • If you see doctors often, these amounts can add up quickly • Check what the maximum out-of-pocket limit is, as these vary from plan to plan; plans with lower monthly premiums tend to have higher maximum out-of-pocket amounts
Next, check for extra benefits: • Not all Advantage plans include dental, vision, and hearing, so make sure your plan includes the extra benefits you want • Ask your agent if there is a Part B reduction plan available to you – this is when the plan reimburses some or all of your Part B premium (not available in all areas)
Finally, you'll want to go over all the important documents: • Summary of Benefits – Check the benefits (including exclusions), deductible amounts, coinsurance and copay amounts, out-of-pocket limit, direct links to preferred provider directory and drug formulary, as well as any referral requirements • Annual Notice of Coverage & Evidence of Coverage – What you'll receive if you're already enrolled in an Advantage plan; These notify you of any changes that will take effect in the plan in the following year • Drug Formulary – If the plan includes prescription drug coverage, this will include all the medications your plan covers; check that all of your medications are included on the formulary – also, check the deductible for prescription drugs, which varies from $0 to $445
The enrollment periods you can use to make changes to your Advantage plan are: • Initial Coverage Election Period • Annual Enrollment Period • Medicare Advantage Open Enrollment Period
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Whether you're enrolling in a Medicare Advantage plan for the first time, switching your current coverage or renewing your current coverage. It's important to know what to review prior to choosing a plan. In this video, we're going to go over our pre-enrollment Medicare Advantage checklist so that you can feel more confident in your decision. Hi Medicare Community. My name is Lindsey Engle. I'm the Medicare expert for Elite Insurance Partners and MedicareFAQ.com. Our pre-enrollment Medicare Advantage checklist will include, checking which doctors are in your plans network, the coverage area, cost-sharing, the summary of benefits, and your drug formulary if the plan includes prescription drug coverage. The first item on our pre-enrollment checklist is Doctor Networks. Medicare Advantage plans are most often HMO or PPO with limited networks. It's important to check that all of your physicians are within the plans network. If you're someone who has multiple doctors, it's important to check that each one does except the plane you're choosing. Also, it's important to take into consideration that if you need to see a specialist, it will require a referral from your primary care physician. The next item on our checklist is coverage area. It's important to know that Medicare Advantage plans do not travel with you. Some plans even restrict you to the doctors within your county. Make sure to consider how often you travel, if you do travel a lot, then a Medicare Advantage plan may not be a good option for you. Now let's go over the next item on the checklist, which is cost-sharing. Cost-sharing varies from plan to plan. It's important to understand all the different forms of cost-sharing your plan comes with. This includes deductibles, coinsurance, and co-payments. You'll want to check how much your copay is to see your primary physician as well as a specialist. If you do see your primary physician a lot having a small copay whether it's $5 or $20 can quickly add up. You'll also want to check what your maximum out-of-pocket limit is. Each Maximum Out-of-Pocket limit does also vary from plan the plan. Usually the lower the monthly premium the higher the out-of-pocket limit will be. Having a good understanding of all the different out-of-pocket costs your plan comes with will help you better prepare for your health care cost. Next on our pre-roman checklist is extra benefits. If you're looking for a plan that covers dental, vision, and hearing it's important to check your benefits because not all will include all three. You can also ask your agent if there's a part B reduction. A Part B reduction is when the plan reimburses you some or all of your Part B premium. This is not available in all areas. The final thing on our pre-enrollment Medicare Advantage checklist is to go over all the important documents. One of those documents is a summary of benefits. This is very similar to the outline of coverage but the format is standardized across all plans. This makes it much easier to understand. The important things to check on your summary of benefits include, the benefits, including exclusions, your deductible amounts, your coinsurance and co-payments amounts, your out-of-pocket limit, and also, should include direct links to your preferred provider directory and your drug formulary and will also include any referral requirements. The next important document is your annual notice of change in evidence coverage. Now, this is what you'll receive if you're already currently enrolled in a Medicare Advantage plan. These are mailed to you each September before the Annual Enrollment Period. These documents will inform you of any changes that will take effect to the plan in the following year. The last important document you'll want to review is your plans drug formulary if it includes prescription drug coverage. The drug formulary or drug list will include all the medications your plan includes. You'll want to make sure that you check that each of your medications is listed on the formulary. You'll also want to make sure you check the deductible for prescription drugs. This can vary anywhere between $0 to $445. The formulary must include at least two drugs per category. It will also include both brand and generic name drugs. Youll want to make sure to review the step therapy criteria. The step therapy criteria will go over certain circumstances in which you may need to try a lower-cost drug before they approve another one. Also, check the prior authorization criteria. In the section, they'll go over which drugs need special approval. In the case your drug is not on the current formulary, you can always request a formulary exception. So that completes our pre-enrollment Medicare Advantage checklist. If you're wondering which enrollment periods you can make changes to your Medicare Advantage plan or enroll in one for the first time. This includes three separate ones. This includes your Initial Coverage Election Period, which comes around when you first agent at 65 or we become eligible due to a disability. The second one is the Annual Enrollment Period, which comes around every fall between October 15th and December 7th. The third enrollment period is the Medicare Advantage Open Enrollment Period, this comes around every year between January 1st and March 31st. For this enrollment period, you're only eligible if you are currently already enrolled in a Medicare Advantage plan. Thank you so much for watching. I hope you enjoyed this video and found it educational. If you have any more questions, feel free to leave a comment below. If you haven't already subscribed to our YouTube channel, make sure to do so. Always have notifications on so you're notified each time we upload a new video. We also have a fantastic Medicare community on Facebook. There will be a link in the description below so you can join. Until next time. Bye.