Open Enrollment is coming, and with it you may begin to see many commercials on TV telling you about Medicare Advantage Plans and their benefits.  

Each year, our MMAP offices receive calls about the promises these commercials make regarding Medicare Advantage Plans or Dual Plans. There are many important pieces of information that are left off of these commercials. So, let’s summarize some of the major points:

Providers. Medicare Advantage plans use contracted provider networks.This means that you need to verify that your doctors, specialists, hospital, and pharmacy are in-network providers for the Medicare Advantage plan, before you sign up for the plan. Provider networks are geography based—so if you are a snow bird you may want to make sure you can receive the care you need wherever you spend your time. 

Copays. Medicare Advantage plans require copays at your health provider offices. The more doctors, hospital days, labs, etc you use, the more you will pay in copays.  Yes, the plans usually have maximum annual out of pocket amounts. To make sure you are choosing the right plan for your use, you will need to compare that maximum to a Medigap policy costs per year. 

Coverage. The “Extra Benefits” like vision, dental, and hearing include very basic coverage. Many commercials boast a $0 Premium health plan, but this plan can include upcharges for “comprehensive dental/vision/hearing services.” If you want more than a tooth cleaning and eye exam, you’ll need to pay the monthly premium for the “comprehensive” covered services, like dental fillings and glasses. 

Important note: many Calhoun Residents over age 60 already qualify for dental, vision, hearing, and transportation services through the Senior Millage, if your income is under 200% of the Federal Poverty Level. 

Savings. The promise of saving $149 a month applies to beneficiaries who qualify for Medicaid premium-assistance programs. A MMAP benefits counselor can screen you  to see if you qualify for this..

Finally, if you leave a Medigap/Supplement policy (used with Original Medicare) in favor of an Advantage plan, you might not be able to get a Medigap back, due to preexisting condition underwriting. 

MMAP counselors can help you fully understand all your choices. Be a savvy consumer and give MMAP a call, before you call the TV 800 number! Schedule your benefits counseling appointment today by calling 1-800-803-7174.

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