Medicare Advantage plans offer an "all in one" solution for healthcare when you're eligible for Medicare. You get access to coverage similar to traditional Medicare, and these programs add additional benefits like prescription drug coverage and dental care.
You have an opportunity to choose a Medicare Advantage plan each year (and more often than that, in some cases), making now an excellent time to evaluate your options.
What's Changing for Medicare Advantage Plans in 2022?
There are several updates that may be new to you in 2022.
Medicare Advantage premiums have been falling in recent years, and that trend is likely to continue. You might have more access to zero-premium plans — in more locations throughout the U.S., insurers are expanding into new markets, and even if you pay a premium, those premiums and other costs could be lower in 2022. What's more, you might qualify for a rebate or receive funds to help offset costs for groceries and other healthy habits.
Cost savings extend beyond your premiums. For example, insurers are now more likely than ever to offer generic drugs with no copay required. While that's not necessarily new, you might notice an expanded list of drugs and participating pharmacies, adding convenience in a busy world. What's more, it may be easier to find coverage for ancillary benefits like vision, dental and hearing care with no copayment required.
Finally, COVID-19 changed our world dramatically, and Medicare Advantage plans are not immune to those changes. You should see streamlined options that make it easy and affordable to prevent and treat COVID-related issues. For example, you likely have additional access to telehealth, which can be convenient when an in-person visit isn't necessary. Telehealth visits are not limited to care for COVID-19, so you can address a variety of health issues from home in 2022.
COVID-19 vaccines, testing and other COVID-related services are often available with no out-of-pocket charges. And if you become seriously ill, your out-of-pocket costs depend on the specifics of your plan. That said, some insurers have been reducing cost-sharing, although they're not required to do so. You might also have increased access to out-of-network providers with no financial penalty, but it's critical to check with your insurer for complete details.
How to Choose the Right Medicare Advantage Plan
Choosing a plan can get complicated, but a skilled insurance professional can help. As you explore your options, be sure to include the following factors:
Costs: Pay attention to monthly premiums, but remember that the lowest premium might not be the least expensive option. After considering copayments and other out-of-pocket costs, it could make sense to choose a plan with a higher premium. Check on deductibles, annual limits and other plan features that affect your budget.
Benefits: Medicare Advantage plans are required to cover everything that traditional Medicare covers. But you might be able to tailor your coverage to include things that are important to you. For example, you might add a gym membership, transportation benefits or coverage for dental and vision care. Also, check if prescription drug coverage is included. If not, you may need a standalone Part D plan.
Ratings: It's essential to review specific features for each plan, but the federal government also provides high-level ratings to help you evaluate plans. The Centers for Medicare & Medicaid Services (CMS) star ratings use a five-star scale to grade plans. One star is the least appealing, while a plan with five stars indicates an excellent experience. All other things being equal, it may make sense to choose a plan with a better rating.
Providers: If you have favorite providers (doctors and dentists, for example) in your area, verify that any plans you're considering are compatible with their office. This may be particularly important if you have specific health conditions or if you plan to address certain issues in the coming year. It's also worth investigating options for out-of-network care as you compare plans.
When to Change Medicare Advantage Plans
If your current Medicare Advantage plan is the perfect fit, that's great. You can often continue with similar coverage unless your insurer makes changes or your healthcare providers move to different networks. But in some cases, a change is in order. Here are some topics that might indicate a need to switch plans:
Doctor and provider availability: If you want to work with a doctor who is not part of your current plan's network, a new plan might solve the problem. Double-check with medical offices and Medicare Advantage providers and get access to the service providers you want.
Prescription drug coverage: If your current plan's drug coverage is lacking, a different plan might offer better benefits. This could be helpful if you develop new health conditions or go on new medications. Plus, Medicare Advantage plans sometimes change drug coverage or move your existing medications to a less favorable pricing tier.
Dissatisfaction: If you suspect that things could be better with a different plan, you might be right. Medicare Advantage star ratings incorporate everything from customer service to health outcomes. Therefore, finding a plan with a higher rating could produce a more satisfying experience and better treatment.
Need for additional services: Medicare Advantage plans offer coverage for services beyond those included with traditional Medicare. If you want coverage for dental, vision, hearing or other services, a new plan (or an update to your existing plan) might be helpful.
Change in health: New health issues can emerge over time, and your existing plan might fall short as your needs change. For example, you may want to change your out-of-pocket maximum or consider a PPO plan for more access to specialists.
Geographic changes: If you move to a new area or your current Medicare Advantage plan stops operating in your area, it makes sense to explore alternatives. You may also want to change plans if you lose access to your favorite pharmacy and your plan does not provide an easy way to get prescriptions.
Medicare Advantage plans in 2022 should continue to improve on offerings that have evolved over the years. Pricing appears to be declining for standard services, and many plans are available with no monthly premium. For 2022, look for increased access to prescription drugs (possibly with no copay required) and ripple effects from the COVID-19 pandemic.
If your current plan is not meeting your needs, shop around — you might find the perfect fit with a new insurer. Medicare offers several opportunities to change your plan, including an annual Open Enrollment Period from October 15th to December 7th. Other events may also allow you to change plans, so speak with an insurance professional to find out what's available.