It’s true that there are several Medical Advantage plans on the market today with $0 monthly premiums. While these plans offer a tremendous value compared to Original Medicare and Medicare Supplement plans, it’s important to evaluate the quality of a Medicare Advantage plan before choosing one. Here are some things to keep in mind.
Health plan quality
Always evaluate the quality of a health plan before purchasing health insurance. The Centers for Medicare and Medicaid Services (CMS) uses a five-star rating system to rank Medicare health and drug plans. One star stands for poor performance, while five stars stands for excellent performance.
“For example, Sharp Health Plan earned a five out of five-star rating from CMS,”* says Don Truong, the director of sales at Sharp Health Plan. You can compare the quality of different plans using the Medicare Plan Finder tool on medicare.gov.
You’ll also want to evaluate the quality of a health plan’s network, including the doctors, hospitals, rehab facilities and other providers available to you through your health plan. You can also find and compare providers using Medicare’s website.
“A Medicare Advantage plan may help lower your health care cost if you have a doctor or medical group you’re already receiving your care from, and if you are ready to retire into Medicare,” explains Truong. Here are some of the most common questions about Medicare Advantage plans.
What is Medicare Advantage?
Private health insurance companies provide Medicare Advantage plans, also known as Medicare Part C. The federal government offers Original Medicare plans (Parts A and B).
“If you want more coverage than what you receive with Original Medicare, a Medicare Advantage plan may be a good choice for you,” explains Truong. “Medicare Advantage plans offer the same coverage as Original Medicare, plus additional benefits.”
At minimum, all Medicare Advantage plans include complete Part A and Part B coverage.
- Medicare Part A (hospital coverage) provides inpatient hospital and emergency room care, home health care, hospice care, and nursing home care.
- Medicare Part B (medical coverage) provides services to diagnose, prevent and treat conditions, including doctor’s visits and lab visits.
- Dental and vision coverage
- Acupuncture and chiropractic care
- Over-the-counter (OTC) benefits
- Free fitness resources
Is a “free” Medicare Advantage plan really free?
Certain Medicare Advantage plans allow you to enroll with a $0 monthly premium. Keep in mind that a $0 monthly premium won’t eliminate every cost associated with your plan.
Here’s what you can expect:
- Medicare Advantage plans often have lower copays and most have no deductible.
- There’s no cost for Part A if you have worked 40 quarters where you paid Medicare taxes.
- You will pay the standard monthly premium for Part B.
Here’s an example of what a Medicare eligible beneficiary could save on their monthly premium with a Medicare Advantage plan:
- With a Medicare Advantage Plan
Original Medicare ($148.50 for 2021 Part B) + Medicare Advantage Plan (Parts A, B and D = $0) = Total $148.50 a month
- Without a Medicare Advantage Plan
Original Medicare ($148.50 for 2021 Part B) + Medicare Supplement (Medigap = Average $157) + Part D (Prescription = Average $33) = Total $338.50 a month
What types of Medicare Advantage plans are there?
There are several types of Medicare Advantage plans, but HMO and PPO plans are two of the most common.
Health maintenance organization (HMO) plans: Most Medicare Advantage plans are HMOs. With an HMO plan, the majority of your care and services must come from providers within your plan’s network.
Preferred provider organization (PPO) plans: With a PPO plan, you’ll have the flexibility to see most health care providers and can pay less if you visit a provider or hospital within your plan’s network.
How do you qualify for a Medicare Advantage plan?
To qualify for enrollment in a Medicare Advantage plan, you must be eligible for Medicare and be enrolled in Original Medicare.
When can I enroll in a Medicare Advantage plan?
You can only join a Medicare Advantage plan during certain times of the year. Consider these points when you’re shopping for a plan:
- If you do not have a Medicare Advantage plan: You can enroll in a Medicare Advantage plan during the initial period when you are newly eligible for Medicare.
- If you already have a Medicare Advantage plan: You can change your Medicare Advantage plan to a different one, or to Original Medicare with or without a Part D (prescription drug plan) during the Medicare General Enrollment Period. This particular enrollment period takes place every year from January 1 to March 31.
- If you want to change your health coverage and add, drop or change your drug coverage: Make your changes during the annual Medicare Open Enrollment Period, from October 15 to December. 7.
Is a Medicare Advantage plan right for me?
A Medicare Advantage plan may help you save time and money. As with shopping for any health insurance plan, it’s important to consider your options.
What you’ll want to look for
When you’re ready to consider a Medicare Advantage plan, Truong has one more piece of advice.
“Simplicity and convenience are key here,” he says. “A Medicare Advantage plan allows you to have everything in one place: Parts A, B and D.” Sharp Health Plan’s newest Medicare offering, the Sharp Direct Advantage® VIP Plan, offers more value and extras with $0 monthly plan premiums, $0 primary care and specialist visits, and other great benefits.”
Still have questions about Medicare?
Sharp hosts free online seminars, where you’ll learn more about enrollment periods and how Medicare works. Sign up for the "Understanding How Medicare Works" seminar or the “Understanding Your Medicare Open Enrollment Options” seminar.
These classes are also available in Spanish. Please visit Entienda Cómo Funciona Medicare for more information.
* Every year, Medicare evaluates plans based on a 5-star rating system.