How to Choose the Best Medicare Advantage Plan for You

Whether you are new to Medicare or want to explore your Medicare options, you may be faced with a new, unfamiliar health insurance decision. Original Medicare, Medicare Advantage, Medigap or Medicare Supplement—What’s the difference? And how do I know which one’s right for me?

These are all questions you might be asking as you look for what kind of coverage you need. In this article, we will focus on the benefits of Medicare Advantage. To learn more about Original Medicare (Parts A & B), Medicare Supplement (Medigap) and Prescription Drug coverage (Part D) check out our Medicare 101 guide.

The Basics of Medicare Advantage

Medicare Advantage, also known as Part C, combines all the benefits of Original Medicare, Prescription Drug Coverage (Part D) and other health and wellness benefits into one easy plan. These plans function similarly to other forms of health insurance you may have used in the past.

Think of Medicare Advantage as the one-stop shop for Medicare coverage. You get hospital, medical coverage and sometimes prescription coverage all rolled into one. These plans may include additional benefits like dental coverage, hearing and fitness benefits, and quarterly cash allowances for qualified medical needs.

The goal of Medicare Advantage is to provide an easier way for you to receive quality care all from one central plan.

When Can I Enroll in Medicare Advantage?

If you are aging into Medicare by turning 65, your first enrollment period can be anywhere from 3 months before your birthday to 3 months after.

Original Medicare Enrollment

Once you begin receiving Social Security, you will automatically be enrolled in Original Medicare (Parts A & B). If you are not automatically enrolled, you can visit Medicare.gov to learn how to enroll. Delaying enrollment may result in some penalties, but by double-checking your status you can avoid those easily.

Medicare Advantage Enrollment
You can choose to enroll in Medicare Advantage in the same 6-month period that Original Medicare activates. If you don’t elect Medicare Advantage at that time or if you are looking to make a change to your plan, there are two yearly Medicare Advantage enrollment periods.

• Annual Election Period: October 15th to December 7th
• Medicare Open Enrollment: January 1st to March 31st

What to Look for When Choosing the Best Medicare Advantage Plan for You

Everyone’s health needs and concerns are different. Here are a few things to keep in mind when choosing the best Medicare Advantage plan for you.

Looking to learn more about Blue Cross® Blue Shield® of Arizona (AZ Blue) Medicare Advantage? Our team can help. Call us at (888) 288-4398 TTY: 711 Monday thru Friday 8 a.m. to 8 p.m. MST.

Coverage and Costs

Healthcare costs are a primary concern of most Medicare recipients. Many Medicare-eligible beneficiaries are on fixed incomes. They are looking for security and stability when it comes to managing their health needs. Most Medicare Advantage plans include low or $0 premiums for coverage.

Medicare Advantage plans may also come with other cost benefits including:

• Low maximum out-of-pocket (MOOP) costs
• $0 or low copays for specialists
• Eyewear allowances
• Fixed hearing aid costs
• Fixed or $0 drug costs
• Fixed costs for ambulance rides or emergency room visits

All of these added benefits help protect you from surprise medical expenses while giving you more value.

Prescription Drugs

Prescription drug cost and coverage is a large concern among Medicare recipients. Seniors or those eligible for Medicare may be on multiple daily prescriptions. Prescription Drug coverage (Part D) is not included in Original Medicare (Parts A & B). It’s a buy-up from traditional Medicare and it will come with its own monthly premiums.

Most Medicare Advantage plans make that easier by building Part D coverage into your plan. These plans may have $0 deductibles for prescriptions. That means fixed drug prices are available the day the plan starts. Plans also have fixed prices for drugs based on their determined tiers.

Let’s break down what prescription tiers might look like:*

• Tier 1 preferred generic: $0
• Tier 2 non-preferred generic: $15
• Tier 3 preferred brand name: $50
• Tier 4 non-preferred brand name: $100
• Specialty drugs: 25% coinsurance

*This list is only an example. Different plans and providers may have different pricing per tier.

Health Care Needs and Services

Your medical needs are another thing you’ll want to think about when choosing a Medicare Advantage plan. Are you relatively healthy with only a few visits to the doctor when sick? Do you have specialists that help you manage chronic conditions?

Once you understand your care needs, compare copays or coinsurance for the types of care you may need. Common copays and coinsurance you should look at:

• Primary Care Provider (PCP)
• Specialist
• Mental Health Care
• Outpatient Surgeries
• Diabetes Support
• Emergency Room
• Alternative Therapies (Chiropractic, Acupuncture, Massage)
• Psychiatric Care

You’ll also need to consider the plan type. Is it a Preferred Provider Organization (PPO) or a Health Maintenance Organization (HMO)? Your plan type often determines if you need referrals to see specialists. For all AZ Blue Medicare Advantage plans, members can see specialists with no referral needed.

Provider Networks

Choose a plan with a robust provider network. As with any health insurance plan, costs will be lower when you choose in-network providers. The bigger that network, the easier it is for you to find care that is fully covered by your plan.

AZ Blue has almost 17,000 in-network doctors and 56 in-network hospitals for you to choose from throughout the state. Want to find out if your care team is in our network? Search our provider directory.

Extra Benefits

Medicare Advantage plans come with many healthy extras that assist you in maintaining your health. They give you access to things like dental coverage, fitness benefits and even quarterly stipends to spend on qualified over-the-counter items.

Here are some of the extra benefits you may get with AZ Blue Medicare Advantage plans:

• SilverSneakers®: Unlimited access to gym memberships nationwide, home fitness kits, health coaching and more
• Quarterly Over-the-Counter (OTC) monetary allowances
• Rewards for yearly annual physical exams and preventive screenings or care
• Free rechargeable upgrade for hearing aids
• Comprehensive & preventive dental plans
• $200 annual eyewear allowances
• Free access to virtual health seminars on varying topics

Is Medicare Advantage Right for Me?

Ultimately, you or your caregivers are the only ones who know your health needs. Choosing Medicare coverage is a personal decision. Make sure you explore all options before selecting your coverage. For those who want the ease of managing their medical care in one place, Medicare Advantage can be a great option.

If you are looking to explore your Medicare Advantage plan options, AZ Blue can help. Call our team at (888) 288-4398 TTY: 711 Monday thru Friday 8 a.m. to 8 p.m. MST.

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