So you’ve decided you want to get your Medicare coverage through a Medicare Advantage plan and not through Original Medicare? Here’s what you need to know to get enrolled.
How to qualify for a Medicare Advantage plan
To enroll in any Medicare Advantage plan, you must meet four requirements. You must:
Already have Medicare Part A (hospital insurance) and Part B (medical insurance).
Live in the service area of the plan you decide to join.
Be a U.S. citizen or be lawfully present in the U.S.
You must already be enrolled in Part A and Part B before enrolling in Medicare Advantage because these plans offered by private insurance companies will replace the Original Medicare plan provided by the federal government.
How to choose the Medicare Advantage plan for you
Next, if you meet all those requirements, you will decide on the specific Medicare Advantage plan you want to join. The companies that offer Medicare Advantage plans are obligated to cover everything Original Medicare covers. But they are also free to add in prescription drug, dental, vision, fitness and other benefits.
Before starting your search for a specific Medicare Advantage plan, list your decision-making criteria and relevant details. As you work through your plan comparisons, you will want this information handy. These criteria could include:
The plan’s costs (monthly premiums, deductibles, copayments, coinsurance and out-of-pocket maximums). [Link to the article defining costs]
Type of plan (HMO, PPO, PFFS, SNP or MSA) [Link to the article defining plans]
Access to your preferred doctors in the plan’s network.
Access to your preferred hospitals in the plan’s network.
Access to your prescribed medications on the plan’s formulary.
Access to additional benefits that are important to you.
The official Medicare website offers a Medicare Plan Finder. By following the prompts, you can perform as many searches as you’d like as a guest on the site. But if you’d like to save the information you are gathering, you will want to log in or create a secure Medicare account on the website.
The Medicare website allows you to search for available Medicare Advantage plans with and without prescription drug coverage bundled in. Unless you have prescription drug coverage elsewhere, you will most likely want to include it here. If so, to make the most of the website’s search tool, first search for the best plan that meets your budget – without considering a drug plan. (The reason? If you can’t afford a plan, it doesn’t matter if all other criteria are met.)
Once you have selected the three plans that best meet your budget, write down their names and use the search tool again, this time including prescription drug coverage. (This will tell you if the chosen plans cover the medications that are critical to you and their cost.) If you are not comfortable with what you find, start your search again for more plans that meet your initial budget needs.
Once you have plans that meet your budget and cover your medications to your satisfaction, check each plan against all your remaining criteria (plan type, doctors, hospitals and benefits). As you continue to use Medicare’s Plan Finder, you may find yourself using it creatively to identify your ideal plan.
How to enroll in a Medicare Advantage plan
To join a Medicare Advantage plan, you will need two pieces of information that are available on your Medicare card:
Your Medicare number (an 11-character ID with letters and numbers).
The start date of your Part A and Part B coverage.
Using your Medicare Plan Finder search results, visit the website of your selected plan to see how you can join and to get contact information, including phone numbers.
These are the enrollment options available to you:
Join online by following the indicated process if that is an option.
Call the company offering the plan to enroll by phone.
Download a paper enrollment form from the company’s website or call the company to request an enrollment form. (All plans have to include this option for people who do not want to enroll online or by phone.) Fill out the form and return it.
Call Medicare at 1-800-MEDICARE (1-800-633-4227) for help with enrollment.
Where to get additional help with enrollment
Besides calling Medicare at 1-800-MEDICARE, Medicare offers Live Chat access to help you 24/7/365 except on some federal holidays. You can also find help within your home state by using the dropdown menu on that webpage to choose your state, then clicking on “Help with my Medicare options & issues” for different available resources.
You may also decide to get help from a broker or agent to help you navigate this important decision. Fortunately, you can change Medicare Advantage plans each year, so you are not making a lifelong decision. (However, by choosing a Medicare Advantage plan, you may be giving up access to some alternatives with Original Medicare supplemental plans.)