Things To Check Before You Buy A Medicare Advantage Plan


Private health plans known as Medicare Advantage (MA) plan to give additional coverage beyond what Original Medicare offers. Medicare Advantage plans in Virginia provide these policies, and prescription coverage (Part D) and other benefits are frequently included in Medicare Advantage plans.

You don’t often need a primary care physician (PCP) or a referral to see a specialist if you have original Medicare. However, a PCP is usually chosen for you by a Medicare Advantage HMO plan, and specialist appointments typically require a referral.

Another factor is that Medicare Advantage plans will collaborate with a network of medical specialists. Make sure your doctor is covered by the MA plan you select by checking to see if they are in the network.

Which Medicare Advantage Programs Are Offered?


Before starting your search, knowing the difference between the various Medicare Advantage plans is essential. When examining your alternatives, you may come across some or all of the following programs:

  • Plans from health maintenance organizations (HMOs). The in-network medical services that are covered by these plans take priority.
  • PPO-related plans (Preferred Provider Organizations). Depending upon whether the service is in or out, these packages have varied pricing. (A “network” is a group of service providers engaged in tasks for the specific insurance company and plan.) These could present more options for seeking medical treatment outside of the network.
  • Plans for private fee-for-service (PFFS). Any Medicare-qualified provider who accepts the appropriate fee from your project can provide you with healthcare under these programs.
  • Plans for Special Needs (SNPs). These programs provide additional assistance for medical expenses related to particular chronic health conditions.
  • Plans for Medicare Savings Accounts (MSAs). These programs combine an increased health plan with a medical savings account.

Every plan provides options to satisfy your healthcare requirements. SNPs help reduce some long-term costs if you have chronic health concerns. On the other hand, if you travel and require out-of-network care, a PFFS or MSA plan might be advantageous.

Considerations For Selecting A Medicare Advantage Plan

It can be challenging to select the best Medicare plan for you with all the changes to the plans already on the market. What to look for in a Medicare Advantage plan includes the following:

  • Fees that are affordable and meet your demands,
  • A list of all the doctors you want to continue receiving coverage from for any services and prescription drugs you know you’ll require.
  • Star rating from the Centers for Medicare & Medicaid Services (CMS).

Continue reading to find out what else you should look for when comparing Medicare Advantage plans.

Check Out The CMS Star Ratings


To evaluate the level of medical and pharmaceutical services offered by MA and Medicare Part D (prescription medication) plans. The CMS has created a 5-star rating system. The CMS makes these star ratings and other information available to the public each year.

The CMS ratings can be a fantastic place to start when looking around for the top MA plan in your state. Consider looking into these plans to learn more about the coverage offered and associated expenses.

Think About Your Top Priority Coverage

All MA plans include hospital and medical coverage in addition to what original Medicare covers.

Before selecting a MA plan, you should consider what coverage you require in addition to the preceding range.

Most MA plans provide at least one of the following extra categories of coverage:

  • Prescription drug coverage.
  • Dental insurance that includes yearly checkups and treatments.
  • Vision insurance that provides for annual examinations and eyewear.
  • Range of hearing, including reviews and hearing aids.
  • Fitness subscriptions.
  • Health-related transportation.
  • Additional benefits for health.

Making a list of the services you want to be covered will help you find the best Medicare Advantage plan. Then, using Medicare’s find a planning tool, you can compare plans that offer the coverage you require. If you find a plan that appeals to you, don’t hesitate to phone the provider and inquire about any extra benefits or coverage they may provide.

Monitor Income And Possible Medical Expenses


Cost is one of the essential aspects to take into account while selecting the finest MA plan. The following cost details are listed with the plans in the find a planning tool:

  • Monthly premium
  • In- and out-of-network
  • Out-of-pocket maximum
  • Copays and coinsurance
  • Yearly deductible for drugs

These costs could range from $0 to $1,500 and beyond based on your state of residence, the type of plan, and the benefits of the plan. To understand your annual expenses, consider the premium, deductible, and out-of-pocket limit. Any mentioned deductible is the sum you’ll need to pay out-of-pocket before your insurance starts to pay. The maximum sum you will have to pay for the services over the year is indicated by any out-of-pocket maximum.

Consider these expenditures in addition to how frequently you will require prescription drug refills or office visits when determining the cost of your plan. Include the probable expenses of specialist or out-of-network visits in your estimate. Consider the possibility that your payment may be less if you receive any governmental aid with finances.

Do You Routinely Use Any Prescription Medications? Does Your Insurance Cover Them?

Prescription drug coverage (Part D) and Original Medicare benefits are included in Medicare Advantage plans. Discover whether the precise prescription medications you take are covered by the plan you’re thinking about and the cost. For instance, certain drugs are available with $0 copays under some MA prescription drug plans (depending on their drug list and drug-tier levels). You should check yearly to see if your plan covers your prescription medications and how much you will have to pay for them because drug lists can change annually.

Would Non-conventional Perks Like Food And Transportation Delivery Be Useful To You?


Other non-medical advantages of specific Medicare Advantage programs include

  • Aid with utility expenses.
  • Having access to and getting help purchasing wholesome foods.
  • Credit for nonprescription products.
  • Assistance for preventing falls.
  • Companionship.

Finding MA plans containing these services may be wise if they make your life easier.

Review Further Advantages You Might Already Have.

This may affect the type of Medicare Advantage plan you need if you already receive other healthcare coverage. Many of your needs are already covered. To see if a Medicare Advantage plan will work better for you or be more affordable, you may always compare the coverage it offers.


When selecting a Medicare Advantage plan, there are numerous things to consider. You’ll be able to choose the method that works well for your medical requirements, lifestyle, and financial situation by doing some preliminary research.

Once you’ve found the MA plan that best suits your requirements, it’s time to enroll and pay your first premium. Remember that there are only certain times when you can join (and leave) a private Medicare Advantage health plan. You can avoid paying a late penalty by keeping track of the times the registration window is available.

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