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Medicare Plans: Factors to Consider for Making Changes

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Medicare Advantage plans may change from year to year. The medical needs of plan beneficiaries may also change.That's why it makes sense to review your options every year.


1.- Primary doctor or main doctor.

Your primary doctor can make the decision to terminate the contract with the Medicare Advantage plan you are enrolled in. The same can be done by any of the specialists. It is your decision whether you want to follow your doctor or your specialist, or change  your doctor.


2.-Specialist or specific hospital.

I want a specific doctor or hospital for my procedure. There are specialists and medical service centers, which have prestige in the community as experts in certain surgical procedures or medical treatments. These have contracts with different health insurance companies, your insurance agent can help you locate the plans that have them as part of their network. For example: Ophthalmology, Cancer,Cardiology, etc.


3.- Cost of Prescription Drugs

All Medicare Advantage plans have one formulary or several formularies that have a list of prescription drugs. Not everyone is the same. It may happen that your medications changed, or that the plan changed the coverage of your medicines. In September of each year the insurance company sends a letter (ANOC) Annual Notice of Changes, in which it relates the main changes that there have in the plans, including medications. That is why it is convenient to compare costs with other plans. The website is a good place to do this.


4.- Cost of the plan: Copayments, coinsurance, etc.

The plans have different copayments for specialists and medical services. For example: HMO has  a lower cost than the PPO. The maximum of out-of-pocket expenditure. (MOOP), varies between plans. This can change year after year, it should be analyzed, especially if you have planned a medical procedure.


5.- Temporary residence in other States.

Medicare Advantage plans cover specific territories. If you travel for short periods, an HMO plan gives you coverage in case of emergencies. If your trips are for extended periods to other states, you should have a PPO plan with national coverage or a Medigap that has no restrictions.


6.- Important changes in my state of health. 

Your health status may change from year to year.   Make sure  your Medicare Advantage plan is the right one to treat your ailment. For example:  Specialists and Hospitals.

7.- I use the plan very little, I have good health. 

If you're in good health and take few medications, you might consider signing up for a plan that returns part of the Part B premium. These plans usually have higher copays, coinsurance, and deductibles than plans that don't return the Part B premium, so since you won't use it, you can save money with the plan change.


8.- I retired and my income went down.

Depending on your new financial situation, you may qualify for Medicaid, Medicare partial premium subsidy programs or prescription drug payment reduction programs. Insurance companies have a Department of Social Services, which can guide you in this chore.

9.- I need other benefits: 

The different plans have more or less coverage in their Dental benefits, Hearing, Vision Care, Transportation, Gym. etc. Analyze your needs.


10.- Dissatisfaction with the service of the plan. 
If the plan is not serving you well, this is the opportunity to switch your Medicare Advantage Insurance company.  

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