MEDICARE BENEFITS

Medicare Advantage plans are an alternative to Original Medicare, Part A and Part B. Instead of having Medicare benefits administered through the government-run program, beneficiaries can choose to get their coverage through a Medicare Advantage plan, available through private insurance companies that contract with Medicare. To be eligible for Medicare Part C, you must:

• Have Medicare Part A and Part B.

• Live in the service area of the Medicare Advantage plan you're considering.

• Not have end-stage renal disease (with some exceptions).

By law, all Medicare Advantage plans must provide at least the same level of coverage as Original Medicare, Part A and Part B(except for hospice care, which Part A still covers). However, some plans may also cover additional benefits, such as prescription drugs, hearing, routine vision and dental, or health wellness programs.

There can be many benefits to Medicare Advantage, also known as Medicare Part C. Perhaps you prefer the convenience of having all of your health and drug benefits under a single plan, instead of enrolling in a stand-alone Medicare Prescription Drug Plan for your Medicare Part D coverage. Or you may be looking for extra benefits that Original Medicare doesn't cover, such as routine vision and dental coverage.

In most states, Medigap plans have the same standardized benefits for each letter category. This means that the coverage for a Plan A, for example, is the same across every insurance company that sells Plan A, regardless of location. This makes it easy to compare Medicare Supplement plans because the main difference between plans of the same letter category will be the premium cost.

Medicare Supplement insurance works differently in Massachusetts, Minnesota, and Wisconsin, which standardize their plans differently from the rest of the country. Insurance companies that sell Medicare Supplement insurance aren’t required to offer all plan types. However, any insurance company that sells Medigap insurance is required by law to offer Medigap Plan A. If an insurance company wants to offer other Medigap plans, it must sell either Plan C or Plan F in addition to any other plans it would like to sell.The best tool for comparing Medicare Advantage plans, all-in-one private plans that provide medical and well as drug benefits, is the Plan Finder tool at Medicare.gov.

Start at the Plan Finder main page, where you can personalize your search by entering your Medicare number (you can also do a general search for your zip code). Answer some questions about the type of Medicare plan you have now (note that the Medicare Advantage plans are called “Medicare Health Plans” in this tool), then click on the name of your plan. After that you enter your medications and dosages, as well as select local pharmacies (or just click “I don’t want to add pharmacies now”). You’ll see a summary page listing the number of Part D prescription-drug plans in your area, the number of Medicare Health Plans with drug coverage, and the number of Medicare Health Plans without drug coverage. You’re given several options on the left side to refine your search, such as capping your monthly premium, but it’s generally best to keep the search more general at this point. If you have health issues, however, change the health status from the default “good” to “poor” to adjust the tool’s estimates of your out-of-pocket costs

Click on “Medicare Health Plans” to see the Medicare Advantage plans available in your area. Focus on the Estimated Annual Health and Drug Costs column (the sixth column), which shows your expected out-of-pocket costs for premiums, co-payments and other expenses for drugs and medical care, based on average health status for Medicare beneficiaries (or for people with poor health, if you changed the status in the refine search tool).

These expense estimates are based on averages, not your personal health care needs, so it’s important to study the plans’ coverage details. You can read about the basic deductibles, co-payments for each tier of drugs, out-of-pocket spending limits and any drug-coverage restrictions for each plan on the main grid. If you want more details, check the plans you’re interested in, then click “compare plans.” The chart below allows you to compare Medicare Supplement plans based on what's offered across the 10 standardized plans that are available in most states.

As you can see, your Medicare costs and benefits can vary, depending on where you live and what’s available in your area. Because of this, it may be worth taking the time to shop around to find the coverage you need at an affordable price.