Should You Get a Medicare Advantage Plan with Your Medicare?

As you approach the age of 65, your first step in obtaining Medicare is to contact the Social Security Administration and sign up.  The ideal time to do this is within three months before you turn 65, during the month you turn 65, or during the three month period afterwards.  You can sign up at a later age, but you will pay more, in most circumstances.

You can read more about how to complete this process by reading my article "How to Sign Up for Medicare."

Once you have signed up for Medicare, your next step is to decide if you want to get a Medigap policy (Medicare Supplement Insurance) or a Medicare Advantage Plan.  In this post I will discuss Medicare Advantage plans, similar to the one I have selected.  You may also want to read my article  "Should You Get a Medigap Supplemental Policy with Your Medicare?"  

Medicare Advantage Plans

When you select a Medicare Advantage Plan you are still using Medicare.  You get your Part A and Part B services directly through your Medicare Advantage Plan.  Your healthcare providers are required to provide you with everything that original Medicare offers except hospice care and research studies.  You will still receive those services; Medicare just covers them directly.

The benefit of getting a Medicare Advantage Plan is that they usually offer extra services in addition to those you would get only from straight Medicare.  Depending on the insurer, these extra services could include vision, hearing, dental and wellness programs.  Some Medicare Advantage Plans charge no premium above what everyone must pay for basic Medicare; others charge a small additional premium.

For example, I have chosen to use Kaiser Permanente in California as my Medicare Advantage provider.  The only additional fee they have is an optional $20 a month for their Plus plan, which includes dental and extra vision benefits.  You need to understand your plan, however, because the fees and services vary from company to company.

All Medicare Advantage Plans must follow Medicare's rules and provide you with the basic services.  However, they can charge different out-of-pocket fees and they may have their own rules about their services, such as requiring you to get a referral from a primary care doctor in order to see a specialist.

Different Types of Medicare Advantage Plans 

There are a wide variety of Medicare Advantage Plans available and choices vary from state to state.  You can choose an HMO, a PPO, a Private Fee-for-Service plan, Special Needs Plans, HMO Point-of-Service plans and Medical Savings Account Plans.

A few months before your 65th birthday, most of the providers in your area will start mailing you brochures about their plans and some will have seminars to explain how their plans work.  Hospitals and senior centers in your community may also sponsor informational meetings.  Selecting the right program for you can be very confusing, so I highly suggest that you talk to your friends who are already on Medicare.  Ask them about the type of plan they are using, what they like about it and what they would change.  It is recommended that you discuss your choices with an agent who represents a variety of insurance companies and types of policies.

You may also need to take costs into consideration.  One of the factors which helped me make up my mind to use Kaiser was the fact that the optional premium was only $20 above the cost of basic Medicare and my out-of-pocket costs were very low ... for example, $10 to $15 for office visits.

On the other hand, the disadvantage was that, when I decided to switch from my prior insurance to Kaiser, I had to change all my doctors.  Some people are so attached to their current doctors that they don't want to make such a drastic change.  My husband was one of those, which is why he chose to use a Medigap Supplemental insurance policy rather than a Medicare Advantage Plan.  Since I am quite healthy and never saw my physician except for an annual medical exam, I did not mind making the change.
 
There is a lot more information that you need to know about Medicare Advantage plans.  In addition to reading brochures, attending seminars, and speaking with an agent, you can learn more by contacting Medicare directly.  I have included the contact information below. 

Contact Information for Medicare:

http://medicare.gov/

1-800-MEDICARE  (1-800-633-4227)
TTY 1-877-486-2048

Questions about Eligibility for Medicare:

Social Security Administration:  1-800-772-1213

To Get Personalized Insurance Counseling:

Call the State Health Insurance Assistance Program which is also called SHIP.  The number is different for each state. The one for California is listed below:

California SHIP:  1-800-434-0222

Regardless of your circumstances, nearly everyone should contact Social Security within three months before or after their 65th birthday and decide what they need to do.  This is the first step you should take in the process.

If you are interested in learning more about preparing for retirement, you may want to check out the tabs at the top of this page.  They contain links to hundreds of articles on family relationships after retirement, the best places to retire in the United States and overseas, financial planning and medical issues.

You may also be interested in reading:

How to Sign Up for Medicare
Should You Get Medigap Supplemental Insurance with Your Medicare?

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