Medicare - Antares Insurance

How to Choose a Primary Care Physician (PCP)

August 5, 2024

by Samuel Health Insurance Medicare Wellness

One key component of a health maintenance organization (HMO) health insurance plan is the primary care physician (PCP).¹ This is the person who will coordinate all of your medical care. You will likely be required to choose a primary care physician when you sign up for your insurance. This is an important decision, so carefully consider your options.

Many Medicare recipients choose HMOs for their health insurance. In fact, 62% of Medicare Advantage recipients have HMO plans.² HMO plans can also be offered by employers³ and are available on the health insurance Marketplace.⁴ If you’re not sure what kind of plan you have, check out Antares’ descriptions of common insurance terms for a brief overview.

Do you already have a doctor that you’d like to continue to use? If so, make sure that this person is in the network for any health insurance plans you might be considering. If you don’t have someone you prefer, how can you find a doctor you like? Antares suggests using these guidelines to narrow your search.

Find an Office

You don’t want to drive far to see a doctor, especially if you aren’t feeling well. Make a list of doctors’ offices that are close to your home. Are they convenient? Are they open on weekends? Look at their office hours to make sure they are available when you are. Call a few of the places that fit your needs, and ask if they’re taking new patients. If they are, see how soon you can get an appointment. You don’t want to have to wait several weeks to see your doctor, so lack of availability is a warning sign that you may want to choose a different office.

One of the best ways to find an office and/or PCP is by asking your friends and neighbors. Many people are eager to share both positive experiences and horror stories about local doctors. You can also look at ratings websites or online community forums for suggestions.

Not sure which plan is best for you?

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Consider Your Needs

You may be tempted to just pick a name out of a hat and go with it, but this is one of the most important health care decisions you’ll make, particularly if you fall ill. All of your healthcare will be arranged and directed through your primary care physician, and you’ll need to see that person if you want referrals to specialists or anything out of the ordinary.

Once you’ve found one or two offices that meet your needs, consider the type of person you feel most comfortable with. Do you want someone fresh out of medical school? Would you prefer an older doctor? Do you have a gender preference? You will likely be discussing intimate issues with your doctor, so you want to feel comfortable with him or her.

Interview Two or Three PCPs

If you have the ability, make an appointment to meet with the PCPs you are considering. Before you speak to a potential PCP, think about the issues that are important to you. Perhaps you have some particular health concerns. Maybe you are a fan of one kind of diet, or a certain type of exercise. Ask the doctor what his or her thoughts are on these subjects. Your primary care physician should be someone that makes you feel confident and comfortable. Don’t settle for anything less.

Once you’ve found the primary care physician you’d like to use, visit Antares to find plans that have your doctor in their networks. The Antares can rank plans based on your needs and can help you find a health insurance plan that includes the doctor you want to use. The best part? The service comes at no cost to you.

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The Benefits of Medicare Advantage

August 4, 2024

by Samuel Medicare

When you turn 65, you’ll most likely begin getting health coverage through a government program called Medicare. That includes Medicare Part A (hospital benefits) and Medicare Part B (medical insurance benefits). You might see that combination called Original Medicare. You’ll have to pay extra for a prescription drug plan (Medicare Part D), and you won’t be covered for dental, vision, or hearing, in most cases.

Some good news: You have options. For instance, you can reap the benefits of Medicare Advantage, also called Medicare Part C, which offers similar health benefits to Original Medicare. However, it is offered through a private insurance company, and Medicare Advantage plans may offer additional benefits such as dental, vision, and hearing coverage.

When Antares licensed insurance agent, Jon Jacobi first opened his Omaha, Nebraska, agency 16 years ago, most of his older adult clients chose Original Medicare with a Medicare Supplement Insurance plan. But he’s noticed a big shift since then. He says that about two-thirds of clients now choose a Medicare Advantage plan. “Medicare Advantage is now the preferred choice,” says Jacobi. “That doesn’t mean it’s the right one for everyone, but if you haven’t reviewed the benefits lately, you may want to look again.”

Answering the following questions can help you determine whether Medicare Advantage may be the right choice for you.

Do you have questions and want help understanding Medicare? Call a licensed insurance agent at (818) 8057113.

1. Do I need prescription drug coverage, and can I get that benefit through Medicare Advantage?

If you take prescription medications, Medicare Advantage plans may be a more cost-effective choice than Original Medicare, says Jacobi. Medicare Parts A and B do not cover prescription drugs. In order to do that, you’ll need to pay for a stand-alone plan called Medicare Part D, which covers prescription drugs.

Some good news: Most Medicare Advantage plans can also include Part D coverage.

Medicare Part D premiums vary by plan. If you have a lower income and need drug coverage, Part D may still be the way to go, Jacobi says. You can also call a licensed insurance agent at (818) 8057113 to discuss your coverage questions.

Not sure which plan is best for you?

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2. Do I want vision, hearing, dental, or wellness plan services?

If you want additional benefits, like vision, hearing, dental, or gym memberships, you may want to consider Medicare Advantage. (Original Medicare doesn’t offer those optional benefits.) “With Medicare Advantage, there’s a whole gamut of value-added benefits, so you’ll be seeing additional savings as these wellness services add up,” he says. Additional benefits can include:

Acupuncture
Chiropractic services
Dental, vision, and hearing (hearing aids)
Gym memberships
Transportation

And that’s just the tip of the iceberg.

Alternatively, you can add more coverage to your Original Medicare plan instead of having a single Medicare Advantage plan. For example:

You can add Part D for prescription drug coverage.
And if you want a vision, dental, and hearing coverage, you can purchase supplemental plans.
You can also choose Medigap (aka Medicare Supplement Insurance), which helps pay for things like deductibles, copayments and coinsurance.

3. Do I want a cap on out-of-pocket expenditures?

Original Medicare doesn’t have an out-of-pocket spending maximum. That means your copayments or coinsurance can continue to add up with no limit. However, a Medicare Advantage plan does have an out-of-pocket spending cap. For 2022, the out-of-pocket limit for these plans is $7,550.

“If you are a low to moderate utilizer of health care, Medicare Advantage is an attractive choice,” says Jacobi. “But if you are a high utilizer of health care, Original Medicare with [Medigap] may be the better option.”

4. Do I get good network coverage?

If you go with Original Medicare, Medigap may be a convenient choice because you won’t have to use certain health care networks or get referrals for specialists. Plus, there’s no service-area restrictions. But if you choose Medicare Advantage, you may have to pick doctors within that plan’s network. You may also need to get prior approval to get certain prescription drugs or services.

But a Medicare Advantage plan may offer you more freedom than you think, says Jacobi. Because the plan is always expanding, you could have much more coverage than you would have even just a few years ago, he suggests.

Need some help? Call a licensed insurance agent at (818) 8057113, or visit us online today.

5. Would I rather have copayments or coinsurance?

Original Medicare charges a 20% coinsurance for most services. That means you’ll pay 20% of the cost of health services, and usually, your insurance company will pay the other 80%. But Medicare Advantage plans, which can be through health maintenance organizations (HMOs) or preferred provider organizations (PPOs), structure your costs differently. They can offer copayments — fixed amounts you pay every time you get health services.

Bottom line: Once you turn 65, you have options besides just Original Medicare. One of them can be Medicare Advantage. Need some help understanding the difference between Original Medicare and Medicare Advantage? Call a licensed insurance agent at (818) 8057113, or visit us online today.

Uninsured? We can help.

Why You Shouldn’t Toss Your Annual Notice of Change Letter

August 2, 2024

by Samuel Medicare

If you’re in a Medicare Advantage plan or a Part D prescription drug plan, be sure to sort through your mail pile and email inbox. In September, your insurance company should send you an Annual Notice of Change (ANOC) letter.

It may seem like another boring piece of mail, but it’s more important than you might think, which is why you need to read it carefully. Analyzing your ANOC letter may help you save money and safeguard the care elements that are most important to you in a plan.

What Is an ANOC?

The ANOC is a letter from your private Medicare insurance company explaining the changes that will be made to your Medicare plan or Part D plan in the following year.

A number of changes can occur, and they can affect any of the following: your monthly premium, annual deductibles, out-of-pocket maximum, copays for medical services or medications, the network of doctors or pharmacies, and the drug formulary (the list of generic and brand-name drugs that your plan covers). If there are changes made to any of these, you’ll need to evaluate what you should do in response.

For instance, your drug plan may no longer cover one or more of the medications you’re taking. If that’s the case, you could enroll in a new Part D drug plan that does provide coverage. Or you might learn that your doctor and pharmacy are no longer in the network. That means you’ll need to look for a plan with doctors in your network or commit to finding new providers who are in network.

Your plan’s out-of-pocket maximum may even change, and if it’s not something you can afford, you can search for a plan with a lower limit.

You should also consider your own health. Do you require a different level of care now than you did earlier in the year? If so, it’s time to make sure your current plan meets your future needs.

Evaluating these changes and shopping around to see what is currently available each year could end up helping you save money on your medical expenses.

A good starting point: Speak with one of our licensed insurance agents who can help you understand all your options. Call (818) 8057113.

If you don’t remember getting your ANOC—or can’t find it—call your plan carrier. (Medicare Supplement plans, or Medigap plans, will not send an ANOC, since they don’t make annual changes.)

Not sure which plan is best for you?

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What to Do After Reading Your ANOC

If you determine that you want to make changes, your next step will be to choose a different plan during the Annual Enrollment Period, which runs from October 15 through December 7. Any changes in your plan will then become effective January 1.

You can compare quotes online to find one that fits your needs and budget.

No changes needed on your part? Then January 1 will simply mark the start of the new year for your existing plan, which will automatically renew.

Once you’ve read through and evaluated the ANOC letter, you should hang on to it in case you have questions about changes in coverage from the prior year’s plan. Many plans send these electronically or store them on your plan’s website to make them easier to save.

Of course, it can be confusing to wade through all of this on your own, especially if you want to make changes. If you need help navigating all the choices, our team of licensed insurance agents can help you evaluate your options and narrow down your choices. They can even help you enroll in a new plan, if you decide that’s what’s needed.

Uninsured? We can help.

Medicare Frequently Asked Questions (FAQ)

August 2, 2024

by Samuel Medicare

Medicare can be hard to understand, especially if you’re close to turning 65 and this is your first experience with it. To get you started, we’ve provided Medicare answers to some of the most common Medicare FAQs..

Who Qualifies for Medicare?

To qualify for Medicare, you need to be a U.S. citizen or legal resident who is 65 or older or under 65 with a qualifying disability or End Stage Renal Disease.

You are eligible to receive Medicare Part A at no charge if:

You are 65 or older and receive retirement benefits from Social Security or the Railroad Retirement Board.
You are 65 or older and eligible for retirement benefits but have not filed for them yet.
You are 65 or older and had Medicare-covered government employment.
You are under 65 and have received disability benefits for 24 months.
You are under 65 and have Lou Gehrig’s Disease (amyotrophic lateral sclerosis) or have received kidney dialysis or a kidney transplant.

Many people do not have to pay a premium for Medicare Part A (hospitalization insurance). However, everyone must pay a premium for Medicare Part B (medical insurance).

Do I Automatically Get Medicare When I Turn 65?

If you are 65 and already receive Social Security, you will be automatically enrolled in Original Medicare (Medicare Part A and Part B). If you do not receive Social Security, you will need to sign up for Medicare with the Social Security Administration.

When Can I Enroll in Medicare?

You can sign up for Medicare during the 3 months prior to the month you turn 65 through 3 months after you’ve turned 65 for a total 7-month Initial Enrollment Period. As an example, if you turn 65 years old on July 15, you will be able to sign up for Medicare from April 1 through October 31.

If you do not sign up for Medicare during your Initial Enrollment Period, you may have to wait until the General Enrollment Period that begins in January. Exceptions, or “Special Enrollment Periods,” may be granted if you’ve lost your employer group insurance coverage.

What Happens if I Don’t Sign Up for Medicare at 65?

If you do not have credible coverage and delay your Medicare enrollment, you may be subject to late penalties. There are two penalties you could be subject to:

The Part B late enrollment penalty can increase your monthly premium by 10% each year you delay your enrollment. In most circumstances, this penalty is imposed for as long as you have your Part B coverage.
The Part D late enrollment penalty can increase your monthly premium by 1% each month you delay your coverage.

Do I Need Medicare if I Have Group Coverage?

Whether you need Medicare if you have group coverage through your job depends on the size of your company. If there are 20 or fewer employees, you will need to enroll in Medicare for health coverage. If there are more than 20 employees, you will likely be able to keep your group coverage without incurring a late penalty if you switch to Medicare later. Talk to your benefits manager to make sure that you have qualifying coverage.

You can still enroll in premium-free Medicare Part A if you also have group coverage. In these cases, one type of coverage will pay your medical bill first and the other coverage will pay the remainder.

If you plan to delay your enrollment because of group coverage, contact Social Security to avoid having to appeal penalties in the future. It is also in your best interest to compare your group coverage against Original Medicare and Medicare Advantage options. You may find unexpected savings.

Can I Work Full-time While on Medicare?

Yes! You can work full-time while on Medicare. You can also carry both employer coverage and Medicare Part A coverage. When you retire or lose your group coverage, you can then enroll in Medicare Part B. You will also have the opportunity to enroll in Medicare Advantage or Medigap.

Do I Have to Sign Up for Medicare if I Have Private Insurance ?

You are not required to enroll in Medicare if you have private insurance. However, you may face late enrollment penalties. You could also end up paying more for similar (or better) coverage. In addition, if you have an Affordable Care Act (ACA) plan when you qualify for Medicare, you will no longer be eligible to receive ACA subsidies.

What Does Medicare Cover?

The Original Medicare program comes with hospitalization insurance (Part A) and medical insurance (Part B) for services such as doctor’s visits, lab tests, and outpatient services.

Does Medicare Cover Prescription Drugs?

Original Medicare doesn’t cover most prescription drugs you purchase at a pharmacy. Private insurance companies sell Medicare Part D drug coverage that you can add to Original Medicare. If you opt for Medicare Advantage coverage, most plans include prescription drug coverage. Be sure to evaluate the plan details for coverage information.

Is There an Alternative to Original Medicare?

Yes. Medicare Advantage plans (also called Part C) are provided by private insurance companies and combine Parts A and B.

Does Medicare Cover Everything?

No. Original Medicare (Parts A & B) has out-of-pocket costs such as deductibles, copays, and coinsurance. A Medicare Supplement Plan (also called Medigap) can help cover some of these costs. You can only buy a Medicare Supplement Plan if you get Parts A and B through Original Medicare and not Medicare Advantage.

What Is Medicare Part A?

Medicare Part A is health insurance that primarily covers inpatient hospital stays. It also covers hospice care, skilled nursing facility services, and—in some cases—home health care.

What Is Medicare Part B?

Medicare Part B is health insurance that covers medically necessary and preventive services, including doctor visits, lab tests, outpatient surgeries, ambulance services, and medical supplies.

What Is Medicare Part C?

Medicare Advantage plans (also known as Medicare Part C) are offered through private insurance companies as an alternative to Original Medicare. These plans bundle Medicare Parts A and B into a single plan.

What Is Medicare Part D?

Medicare Part D is prescription drug coverage purchased through private insurance companies. It can be used in conjunction with Original Medicare, but not with a Medicare Advantage plan that already includes drug coverage.

What Is Medigap?

Medigap (also known as a Medicare Supplement plan) is offered by private insurance companies to help cover some of the out-of-pocket costs of Medicare Parts A and B, such as copayments, coinsurance, and deductibles. There are several plans to choose from with varying levels of coverage.

Who Can Answer My Medicare Questions?

Have your own set of Medicare FAQs? If you or someone you know is eligible for Medicare or is about to become eligible and want to learn more, contact a Antares licensed agent. Call +1 (818) 8057113 or find a Antares agent near you.

When you’re ready to look into Medicare Advantage or a Medicare Supplement plan, shop online with Antares. It’s quick, easy, and comes at no charge to you

Special Needs Plan: What It Is and Why You Might Want One

July 9, 2024

by Samuel Medicare

When it comes time for enrollment“>open enrollment each fall, you may hear about the Medicare Advantage Special Needs Plans (SNPs). These are a type of Medicare Advantage plan for people with additional heath needs, often due to a serious or chronic condition such as diabetes or dementia. They are also available to people who qualify for both Medicaid and Medicare.

The plans are fairly common: Almost 4 million people on Medicare were enrolled in one in 2021, according to the Kaiser Family Foundation.

SNPs are tailored for people with specific diseases or characteristics. This is important for anyone experiencing a chronic health issue, but especially for older adults, who are living longer and becoming a larger percentage of our population, according to the United States Census Bureau.

And the older you are, the more at risk you become for certain chronic conditions. But SNPs can also be tricky to figure out. Here’s what you need to know.

What is a Medicare Special Needs Plan?

A Medicare Special Needs plan is a type of Medicare Advantage Plan available only to people who have certain qualifying health conditions or situations.

There are different types of SNPs, and they offer specialized care and expanded coverage for specific health conditions and situations. For example, if you have heart disease or live in a nursing home—or if you qualify for both Medicare and Medicaid—an SNP can help meet your specific needs.

Who can join an SNP?

Anyone who is eligible for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), lives in the plan’s service area, and meets the plan’s eligibility requirements can join an SNP.

What are the different types of SNP plans and eligibility requirements?

There are several kinds of SNPs, and to be eligible to sign up, enrollees must meet the qualifications for at least one of these:

Chronic Condition SNP (C-SNP). About 9% of SNP enrollees are in these plans, which are for people with at least one of these chronic conditions:

Alcohol or other drug dependence
Autoimmune disorders, including rheumatoid arthritis and systemic lupus erythematosus (SLE) (not all autoimmune conditions qualify)
Cancer (excluding pre-cancer conditions)
Cardiovascular disorders, including coronary artery disease
Chronic heart failure
Dementia
Diabetes
End-stage liver disease
End-stage renal disease (ESRD) requiring dialysis
Severe blood disorders, including hemophilia and sickle-cell disease
HIV/AIDS
Chronic lung disorders, including asthma and emphysema
Chronic and disabling mental health conditions, including bipolar disorders and major depressive disorders
Neurologic disorders, including epilepsy, multiple sclerosis and Parkinson’s disease
Stroke

Institutional SNP (I-SNP). You live in an institution (like a nursing home), or you require nursing care at home. About 2% of SNP enrollees are in these plans.

Dual Eligible SNP (D-SNP): You have both Medicare and Medicaid. This is the most common SNP, with about 89% of enrollees in these plans. People with D-SNP can receive support in coordinating their Medicare plan with Medicaid, since it can be confusing to work through all the details. In addition, a D-SNP provides benefits that Medicare alone or Medicaid alone does not.

How does a Medicare SNP work?

Medicare SNPs must provide you with the same benefits as Original Medicare, but they usually offer more help and covered benefits than Original Medicare or other Medicare Advantage plans. This additional care includes:

A care coordinator. This person will help you stay healthy and follow your doctor’s orders. For example, a care coordinator for a person with diabetes on a C-SNP might help you monitor your blood sugar, eat right and exercise, and schedule preventive services such as eye and foot exams.

If you have a D-SNP, your care coordinator may help you access community resources and schedule transportation to doctor appointments.

Specialized care. Your SNP is designed to specifically serve people in your situation or with your condition. If you have a C-SNP, for example, for type 2 diabetes, your plan could include blood glucose and insulin management tools, vision, hearing, dental, and routine foot care—services that might not necessarily or normally be available with a non-SNP plan or Original Medicare. These are all features you may need to help you manage your disease.

Drug formularies tailored to your condition. The drug plans for SNPs are designed with a person’s treatment plan in mind. That means it most likely offers coverage for the most common medications prescribed to manage a person’s chronic condition. For example, someone with a heart condition such as congestive heart failure or asthma would typically have medications covered that are most used to treat that specific issue.

How much do SNP plans cost?

That depends. SNPs generally don’t cost more than other Medicare Advantage plans. But because some SNPs offer additional care, they may charge a monthly premium in addition to the base premium. This may mean paying a little more each month, but the tailored could possibly save your money and help safeguard your health. SNPs also set their own deductibles, copayments, and other cost-sharing for services. But if you’re on a D-SNP plan, there are no deductibles or copays if you stay in network.

In addition, SNPs cannot charge more than Original Medicare charges for certain kinds of care, including chemotherapy, dialysis, and skilled nursing facility (SNF) care. But SNPs can charge higher copays for other services, including home health, durable medical equipment (DME), and inpatient hospital care. All SNPs are required to provide Part D coverage.

Can I get my healthcare from any doctor or network?

Usually, you need to stay in the Medicare SNP network, which is generally geared toward your specific needs or condition. There are two exceptions, however:

Emergency or urgent medical care
If you have end-stage renal disease and need out-of-area dialysis

You also generally need a referral to see a specialist, unless it’s for preventive services such as a mammogram or a Pap test and pelvic exam.

What questions should I ask before I enroll in an SNP?

Just as you would before joining any plan, your questions should be geared toward your individual needs. Here are some examples of things to ask to help you narrow down your choices.

How do the SNP’s services compare with other plans available?
What benefits does the SNP provide that will help with my special needs? For example, what special services will help me manage a chronic condition or improve my care in a nursing home?
What costs should I expect for my coverage (premiums, deductibles, copayments)?
Is there an annual limit on my out-of-pocket expenses?
Will I be able to use my doctors? Are they in the plan’s network? If I join an Institutional SNP, will the plan’s network include my nursing home or home care provider?
Am I ever allowed to go out of network?
Do I need a referral to see a specialist?
Are my drugs on the plan’s formulary?

Can I lose my SNP plan?

Yes, you can lose your SNP plan if you no longer meet its eligibility requirements (you lose Medicaid coverage, for example). The SNP will notify you that you’re no longer eligible for the plan, and you’re given at least another month to find another plan. Once you lose eligibility, you’ll have a three-month Special Enrollment Period to make another choice, either a new Medicare Advantage Plan or Original Medicare and a Part D plan.

5 questions to ask before you let your Medicare benefits auto-renew

July 8, 2024

by Samuel Medicare

If you’re on Medicare, you might be glad to have enrolled in it once. And for that reason, you may never be tempted to review your plan’s coverage ever again. It would certainly be your right to do that; your benefits would simply auto-renew each year. But it may be in your best interest.

It’s a good idea to review your coverage every year to make sure you get the protection you need, says Michelle Katz, a Medicare advocate in the Washington, D.C., area.

Let’s say Medicare’s Annual Enrollment Period (AEP) is coming into focus. Instead of letting your Medicare plan auto-renew, here are 5 questions to ask yourself.

Thinking about switching Medicare plans? Call a licensed insurance agent at (818) 8057113 from 8 a.m. to 8 p.m. Monday through Friday (ET) to talk about plans, or browse your options online today.

1. Have your total costs changed?

It’s important to start with how your medical needs have changes year over year. It’s entirely possible that you could’ve had a new health issue pop up. You’ll want to do the math on all of your potential out-of-pocket costs. Those could include:

Your copayments or coinsurance (a fixed price you’ll pay for covered health services)
Your deductibles (what you have to pay out of your own pocket before your plan pays the rest)
Your prescription drug costs (in other words, what you pay for the medication or medications you’re currently taking)
Your premium (that’s your monthly insurance bill)

These are all costs you’ll have to pay out of pocket on a regular (or monthly) basis. You’ll want to be fair with yourself: Do you have enough saved up to cover it? You’ll also want to be aware of what your plan’s annual out-of-pocket limit is so you can see if it lines up with your estimate. If your out-of-pocket costs are more than you can afford, it might be a good idea to shop around for a plan with a lower out-of-pocket limit during Medicare’s AEP.

One other cost-related thing to keep in mind: Your plan’s benefits and costs may change from year to year. Maybe the monthly premium you’re paying for your Medicare plan may be going up. Or, one or more of your medications will no longer be covered by your Medicare Part D (prescription drug) plan.

That’s why it’s a good idea to check your Annual Notice of Changes. That’s a letter from your private Medicare insurance company that explains the changes that will be made to your Medicare Advantage plan or Part D plan in the following year. You’ll get that in the fall, and it’ll include any changes that may have been made to costs and coverage.

Not sure which plan is best for you?

Speak to a licensed insurance agent

2. Has your provider network changed?

Let’s say you’re on Medicare Advantage (MA). That’s a type of Medicare health plan offered by a private company that contracts with Medicare. (You might also see it called Medicare Part C.)

When it comes to MA plans, in many cases, you may only use the doctors who are in your MA plan’s network and service area. That would be for non-emergency care. That means if you use your plan’s in-network doctors, you will likely only have to pay a copay or coinsurance when seeing your doctor or a specialist. (Speaking of specialists, you may also need to get a referral to see them if you have an MA plan.)

It’s important to check that your doctors are still in your plan’s network and that the providers in the plan are in locations that are convenient for you, says Katz. “It’s very common for doctors to drop a plan, and you can’t always trust that they’ll remember to tell you,” she explains.

With that in mind, if you have to use a provider outside of your MA plan’s network, it may cost you a lot more. While some MA plans offer non-emergency coverage out of network, typically it’s offered at a higher cost. So, if you think you’ll need to use any out-of-network providers, you’ll want to add that to your estimate.

You’ll also want your pharmacy to be in your plan’s network. Make sure that all your drugs are covered under the plan’s drug list (formulary) and that you’re familiar with the coverage rules that apply to your prescriptions.

3. Has your plan’s star rating changed?

Each Medicare Advantage and Part D plan has a star rating, which measures the plan’s overall quality and performance. A plan can get a rating between 1 and 5 stars, with a 5-star rating considered high performing. It’s a good idea to check whether your plan’s star rating has gone up or down, as well as whether there are any other 5-star plans you can switch to.

4. Have your health needs changed?

If your health needs have changed, you may need a different plan. For example, you may need:

Better access to health care services
Better-quality health care, based on your changing needs
To make more doctor visits
To take different or more prescription drugs

In all cases, you may want to shop around for a new plan. You can do this by calling a licensed insurance agent at (818) 8057113 from 8 a.m. to 8 p.m. Monday through Friday (ET) to talk about plans, or browsing your options online today.

5. Do you want additional benefits that are not covered by your plan?

Medicare Part A and Part B (often referred to as “Original Medicare”) doesn’t cover benefits such as dental, vision or hearing, but — say, your audiologist suggests that you get a hearing aid in one or both ears — you may want to consider another plan. You have options:

If you’re on Original Medicare, you can add a Medicare Supplement (Medigap) plan, which can help pay for additional health care costs, such as copayments, coinsurance and deductibles.
If you wait until AEP, which kicks off on October 15 and runs through December 7, you can switch to an MA plan. Most MA plans cover benefits that Original Medicare doesn’t.

Even if you’re happy with your current health coverage, it’s important to know your coverage options and to compare other health and drug plans during AEP season, says Katz. You may find Medicare coverage that better meets your needs for the upcoming year. A good way to start that process is by calling a licensed insurance agent at (818) 8057113 from 8 a.m. to 8 p.m. Monday through Friday (ET) to talk about plans, or by browsing your options online today.