• Am I comfortable with my care choices being directed by a private insurance company over the advice of my doctor?

• Am I comfortable losing my Medigap coverage if I switch to Medicare Advantage?

• Am I willing to travel outside my general home area for care?

• Can I get the same medications I am currently prescribed without having to try other medications first?

• How important are limits on my annual maximum out-of-pocket costs?

• Medicare Advantage can change from year to year while Traditional Medicare is more stable. Am I comfortable with that?

• How do I feel about a Medicare Advantage plan disagreeing with the care my doctor believes is reasonable and necessary?

• Will my current doctors accept Medicare Advantage coverage?

• Will I be more likely to seek medical care if it is:

1.  Easily accessible and almost all doctors and facilities are available?

2.  Convenient coverage is available for care in most geographic areas?

3.   If my healthcare needs change, does the Medicare Advantage plan have specialists and hospitals close by to treat me?

If you’re already enrolled in Traditional Medicare, you received an annual notice-of-change letter, which details any changes in your plan’s benefits.

Ask your health care provider and local hospital about Medicare Advantage’s prior approval and authorization practices.

A limited number of doctors and hospitals may accept Medicare Advantage. Write down any doctor, hospital, or medical clinic you may need. Call each of them to ask what Medicare Advantage plans they accept and if they will do so in the future.

Medicare Advantage can look inexpensive; however, there may be significant out-of-pocket costs.

If a Medicare Advantage plan denies the care your doctor recommends, you could be required to pay for the care out of pocket. For many people, opting for Traditional Medicare plus a Medigap plan offers more transparency and financial security.

Medicare Advantage plans sometimes require approval to see specialists or to receive health care such as tests, treatments, or labs. The insurance company might disagree with, or not pay for, the course of care recommended by your doctor.

• If a doctor I need to see is out-of-network, will the plan cover my visits? Will I pay more out of pocket for an out-of-network doctor or hospital?

• What is the service area for this insurance plan and how far could I have to travel to find an in-network specialist or facility for specialized services?

• Does my doctor need to get approval from the plan to admit me to a hospital?

• Do I need an approval from my doctor to see a specialist?

• Are there higher copays and deductibles for certain types of care, such as hospital stays, home health care, or rehabilitation care?

• Does the plan cover any services that Traditional Medicare does not? Are there any rules, policies, or restrictions that I need to be aware of before accessing these benefits?

• Does the plan impose any coverage restrictions on prescription drugs? Ask specifically about your current prescriptions.

• How much will I have to pay for brand-name drugs?

• Will I be able to use my local pharmacy?

• Will the insurance plan cover me when I travel out of state?

• Does the plan require prior authorization for skilled nursing care after hospitalization and are there any rules, policies, or restrictions that I need to be aware of?

When you enroll in Medicare at age 65, you have a guaranteed right to purchase a Medigap plan. Medigap is required to renew coverage each year as long as you continue to pay your premiums. You give up Medigap if you move to a Medicare Advantage plan. If you decide to switch back to Traditional Medicare, Medigap plans can turn you down or charge you more due to pre-existing conditions.
 

Research the difference between Traditional Medicare (Part A and Part B, including Medigap) and Medicare Advantage (Part C).

There is help out there.

To learn more about Traditional Medicare versus Medicare Advantage, contact your local health care providers. Help is also available through the State Health Insurance Assistance Program (SHIP), offered through the Mississippi Department of Human Services, at 1-844-822-4622 or visit https://www.mdhs.ms.gov/aging/finding-services-for-older-adults/. The SHIP service line is staffed Monday through Friday, 8 a.m. to 5 p.m.