Questions to Ask When Choosing a Medicare Advantage Plan

November 21, 2022

Questions to Ask When Choosing a Medicare Advantage Plan

Medicare Advantage (Part C) plans are not one size fits all – here are some questions to keep in mind when exploring your options for Medicare Advantage (Part C) plans.

Provider & Hospital Questions

  • Are my current doctors in this plan’s network?
  • Does this plan cover providers I may need to see in the future?
  • Will this plan cover out-of-network visits?
  • Which facilities (hospitals, home health, skilled nursing) are in this plan’s network?

Access Questions

  • What is the plan’s service area?
  • Does the plan have any coverage for care outside of the service area?
  • What are my options for choosing a Primary Care Provider?
  • Does the plan require approval before I am admitted to a hospital?
  • Do I need referrals from a Primary Care Provider to see a specialist?

Cost Questions

  • What costs are associated with this plan (copayments, deductibles, premiums)?
  • What are the maximum out-of-pocket costs?
  • What is the deductible? (How much do I have to pay before coverage begins?
  • What are the copayments for regular services like seeing a PCP or specialist?
  • What are the copayments for hospital stays and home health?

Benefit Questions

  • Does this plan cover dental, vision, or hearing aids?
  • Are there restrictions or rules to be aware of when accessing my benefits with this plan?

Prescription Drug Questions

  • Are outpatient prescription drugs covered under this plan?
  • Does this plan cover my current prescriptions?
  • Are there any coverage restrictions?
  • What are the premiums, deductibles, and copayments?
  • How much will I pay for generic drugs? Brand name drugs?
  • What will I pay for drugs during the coverage gap?
  • Is my current pharmacy covered?
  • Can I use a mail-order pharmacy?
  • Will I be able to refill my prescriptions when I travel?

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