October 15, 2015

Seniors (or adult children helping parents), take time to match the plan with your own needs.


Choosing a health insurance plan can be complicated. It doesn’t get any less so after age 65, when you qualify for Medicare.

Open enrollment in Medicare Advantage plans begins Oct. 15 and continues through Dec. 7. Now is a good time to review some tips to help pick a plan that best meets your needs. And if you are helping your parents navigate this decision, these tips are for you, too.

What is Medicare Advantage?

Medicare Advantage is optional and provides additional coverage available to those enrolled in Original Medicare, which is offered through the federal government to people over 65. Private insurance companies, such as Aetna, United and Humana, offer Medicare Advantage plans. Medicare Advantage is sometimes referred to as “Part C.” It includes both Part A (hospital care) and Part B (medical care).

While one Medicare Advantage plan may be great for one person, it may lack in what another person needs. For example, someone with vision problems may want to focus on plans with extra vision benefits. Someone else may not want the cost of added coverage for vision services.

Here some tips for choosing a Medicare Advantage plan:

  • Determine what kind of coverage and benefits you need. Each option offers different benefits. It helps to identify first which benefits are most important to you. For example, do you need regular eye exams or a hearing aid? Do you have a chronic illness like diabetes? If so, make sure the plan you choose includes that kind of coverage.
  • Explore all the plans offered in your area. Even if you like your current plan, there may be a better plan to meet your specific needs. The Medicare website offers a personalized plan finder that will let you search for plans available in your area.
  • Understand the difference between Medicare Advantage HMO and PPO plans. In an HMO (health maintenance organization) plan, you typically have to visit a hospital or physician on the plan’s approved list of providers, except in emergencies. With a PPO (preferred provider organization) plan, you can choose your hospital or physician. A PPO still has a preferred network of hospitals and physicians, and you’ll pay less for a visit to a preferred provider. However, if you would like to visit a non-preferred provider, you can but may have to pay more to do so.
  • Make sure your hospital and physician of choice is included in the plan’s provider network. Different plans include different facilities and doctors or other providers. If your hospital or provider is not in the plan’s network, you may have to pay more for care.
  • Check quality ratings for each plan. Medicare’s Hospital Compare website and other tools, Consumer Reports and NCQA are excellent sources for seeking quality ratings based on 5-star ranking systems. At these sites, you can compare hospitals, providers and insurance plans.
  • Read the fine print. Be sure you understand the plan’s co-pays, deductibles and other important plan details. It’s essential that you know in advance how much you’ll have to pay for a doctor’s visit, procedure or hospital stay.

Talk to your insurance broker about the best Medicare Advantage plan to meet your needs.