Keys to Your Best Advantage Plan

The Advantage Plan Shopping Season

‘Tis the season. No, not Christmas season; instead, ‘tis the season to hear those Advantage Plan commercials. And it’s almost the season to shop Advantage Plans.

If you are currently on an Advantage Plan, or if you are currently on Original Medicare (and, most likely, on a prescription drug plan), and are open to a “better deal,” then your shopping season is nearing. That “shopping season” is, technically, called the Annual Enrollment Period (AEP), and it lasts from October 15 through December 7.

What You Can Do During AEP

So, what can you do during AEP? During this Annual Enrollment Period, you can disenroll from an Advantage Plan and return to Original Medicare, or you can enroll on a prescription drug plan (which will automatically replace the drug plan you currently have or the Advantage Plan you currently have—if that Advantage Plan has a drug plan within it) or an Advantage Plan (which will automatically replace the Advantage Plan you currently have). Any plan on which you enroll during this period will begin January 1.

By the way, you only get one choice during AEP, so make it a good one. Once you choose a new plan, it is locked in to begin January 1. (However, if you feel you have made a mistake by enrolling on a particular Advantage Plan, you may disenroll from that plan between January 1 – February 14. Once you do, you will return to Original Medicare and will have the option of choosing a drug plan at that time.)

Open to a Different Medicare Advantage Plan?

If you currently have a Medicare Advantage Plan, and if you like how that plan works for you, you do not have to change it. You can simply do nothing, and your plan will roll over into next year.

However, it is good to keep in mind a few things about Advantage Plans. First, even if you like how your plan works for you, you still may not be able to keep it. From time to time plans go away in specific service areas. That means you could receive a notice that your particular plan will not be available in your area for 2017. If that happens, you will have no choice but to enroll on a different plan or return to Original Medicare.

Second, even if you like how your plan has worked in 2016, your Advantage Plan could make changes for 2017 that you don’t like. When you receive notification of changes to your plan, make sure you look over those changes carefully; or contact your insurance agent, and ask him to explain the plan changes for 2017. (If your agent seems unaware of those changes, or if he or she does not seem interested in taking the time to meet with you about those changes, it may be time to find another agent—one who has your best in mind.) It is very important that you are comfortable with those changes before you decide to keep your plan for 2017.

What to Look for in an Advantage Plan

When shopping Advantage Plans, you will want to keep in mind some important keys to getting the Advantage Plan that is best for you. First, only look at Advantage Plans in your service area; that is, make sure your zip code is included in the service area of any Advantage Plan you look at. For you cannot enroll on a plan outside of your service area. (PPO Advantage Plans tend to have a bigger service area than do HMO Advantage Plans. By the way, if you are not now on an Advantage Plan, but would like to enroll on one, you will need to have Medicare Parts A & B, be in the service area of any plan on which you enroll, and you must NOT have End-Stage Renal Disease [ESRD].)

HMO Advantage Plan vs a PPO Plan

Second, make sure your doctors are in the network of the Advantage Plan in which you are interested. If you are looking at an HMO plan, you must see doctors within the network in order to be covered by the plan. (Seeing a doctor outside of the HMO network means you will pay 100% of the bill.) With a PPO plan, you can go out of network to see doctors, but you will pay more for those doctor visits.

Keep in mind that an HMO Advantage Plan works differently than a PPO plan does. With an HMO plan, you must get a referral from your primary care physician in order to see a specialist (or to get other medical treatment)—or else the visit or treatment is not covered—with a PPO Advantage Plan, a referral is not typically required. This is an important distinction, particularly, if you want more choices in seeing specialists.

Know Your MOOP

Third, do NOT enroll on an Advantage Plan based on its premium. Yes, a zero premium is nice, but keep in mind that an Advantage Plan is a cost-sharing plan, meaning you will have copays when you use the plan. Make sure you know what those copays will be and what your maximum out-of-pocket (MOOP) cost could be.

The MOOP on a plan is the maximum amount you could be out of pocket in any calendar year. For example, the plan in which you are interested may have a MOOP of $6,700. So, even if the Advantage Plan has a low (or no) copay for your primary care physician office visit, if you are in the hospital a few times and have out-patient tests (especially high-dollar tests, such as MRIs and CT scans) and see several specialists, you could end up owing $6,700. Are you comfortable with that? Can you afford it? At least make sure you think through these issues before enrolling on an Advantage Plan.

Need More Help?

In shopping for an Advantage Plan, it can be to your advantage (no pun intended) to sit down with an independent agent who represents two or more Advantage Plans. If you are interested in looking at another (one other than the one in which you are currently enrolled) plan, make sure your agent goes through ALL of the summary of benefits, explaining each benefit to you. That way, there will be no surprises later. (Generally speaking, Advantage Plan surprises are not a good thing.) Of course, there still could be questions later, so, hopefully, you pick an agent who will return your calls and patiently answer any and all questions you may have.

When shopping for an Advantage Plan this AEP, keep in mind these key points of information. If you do, your Advantage Plan experience should be a better one. So, here’s to happy shopping!


Sabrina HightowerSabrina Hightower
14:06 17 Jun 25
genuine care and compassion for clients . Listens and offers plans suitable for each individual. Thank you
Kevin JeffersKevin Jeffers
21:17 16 Jun 25
John was very prompt in responding to my initial call regarding Medicare and was willing to travel from Tyler to... Longview to meet in person. His knowledge of Medicare and supplemental plans gave me confidence that I have the right coverage and his assistance simplified the signup process.read more
John StuartJohn Stuart
01:19 06 Jun 25
I didn't know how to proceed with my medicare and a supplement so I did a Google search found John he had really good... reviews came out to our house explained everything I needed to know and now my supplement pays the majority of my plan B Medicare very happy we found John as are agentread more
pete damronpete damron
16:53 13 May 25
Since retiring, I have come to regard John Claeys Group insurance services as a trusted authority. John's personal... engagement with clients is exceptional, as evidenced by his prompt responses to questions and his ability to resolve issues with insurance providers and the Medicare system. My wife and I feel confident in his service. I highly recommend him to anyone seeking expert insurance guidance. His professional approach and in-person meetings are distinct advantages.Peter C Damronread more
Linda S RayLinda S Ray
19:18 08 May 25
John was a tremendous help with my process of signing up for Medicare. He was patient with my many questions and even... provided step-by-step instructions and links to what I needed to do to sign up. He basically did all of the research to find the best drug and supplement plans for me, and explained all of it in terms I could understand. At the time I called him, I was feeling pretty overwhelmed by the choices. He quickly responded to my emails and calls and knows Medicare inside out. He made a process I was dreading into no problem at all, and I truly appreciated his assistance and his friendly, gracious honesty. I believe he truly cares about the people he is helping and wants the best for his customers. I highly recommend him for anyone who needs help with the Medicare process. Thank you, John!read more
christine hancockchristine hancock
15:38 07 May 25
John is very professional & helpful in explaining insurance. He works to get a good price & what will benefit you the... most. I would highly recommend his services.Christine Hancockread more
Harry MilnerHarry Milner
19:20 28 Apr 25
John Claey is the consummate professional who knows the insurance business inside and out it seems to me based on my... experience and he's been very helpful in setting up my insurance program for secondary Medicaid assistance. It's my good fortune to be associated with him and will continue to do business in the future. Sincerely Harry Milnerread more
Mitch AndrusMitch Andrus
15:27 28 Apr 25
Karma CrispKarma Crisp
02:10 08 Apr 25
robert gordonrobert gordon
21:14 07 Apr 25
Very happy with Mr. Claeys. He is very helpful and got all of our insurance set up. Would definitely recommend his... services.read more
Sherry McEwanSherry McEwan
16:49 07 Apr 25
Bobby BaileyBobby Bailey
15:57 05 Apr 25
Mr CLAEYS WAS VERY FRINDLY AND VERY HELPFUL
Ashley HinkleAshley Hinkle
02:30 04 Apr 25
John was very pleasant and helpful with us choosing a great plan that fits our needs!! Highly recommend!!!
Dana MortonDana Morton
21:47 03 Apr 25
Knowledgeable and very helpful
Mary GriggsMary Griggs
15:36 03 Apr 25
I thought I could manage signing up for Medicare myself. But it just raised more questions. John Claeys really helped... me negotiate the process and made it painless! I recommend him to all my friends.read more
Paulette LangleyPaulette Langley
13:55 25 Mar 25
Bill AyresBill Ayres
23:53 24 Mar 25
The Claeys Group did an exceptional job in setting my wife and myself up for Medicare program! Thank you very much!
David CurrierDavid Currier
23:15 24 Mar 25
Thank you John Claeys for all the information you gave us about the supplemental Insurance. You are the best. If you... need supplemental Insurance I highly recommend John. He is very professional and is very caring about your needs. He strives to get you the best insurance for your needs and at the lowest cost possible.read more
Deb LewisDeb Lewis
20:20 24 Mar 25
John was very knowledgeable regarding the best insurance for us and setting it all up.
Duane ZookDuane Zook
14:53 15 Mar 25
I was looking for some help and wisdom on making a decision on Medicare and supplemental plans as well as prescription... plans. I called John and he came over and was so very helpful. One of the things I really appreciated was his patience with all of my questions. And I had a lot of them. He is available to me whenever I have a question. Thank you, John. I highly recommend him.Duaneread more
Richard PierceRichard Pierce
14:28 19 Feb 25
Very knowledgeable, very friendly, very helpful. I highly recommend him and his service. EXCELLENT IN EVERY WAY.
Buck LeeBuck Lee
23:20 18 Feb 25
John is very helpful, and knowledgeable about the intricacies of Medicare. Also excellent communication and no sales... pressure. Highly recommend.read more
Kim OdetteKim Odette
23:06 18 Feb 25
John Claeys has been so helpful and knowledgeable when it comes to understanding Medicare, the supplemental plans,... drugs plans and navigating what options are best for your financial situation. I highly recommend John for all your questions and assistance with signing up for Medicare and the associated plans.read more
Mark ChildressMark Childress
21:30 18 Feb 25
If anyone needs help with their medicare or insurance needs John is your man. Anytime I have questions I can call him... and he will answer all of my calls. He takes time to explain to me my questions. Can't go wrong with John.read more
Maurita MyersMaurita Myers
21:17 18 Feb 25
John was a true blessing! My husband and I both recently enrolled in Medicare and John walked us through the process.... He is very knowledgeable and keeps us informed of changes that could impact us. We highly recommend his service!read more
kristi daviskristi davis
16:10 07 Feb 25
Gina Sue BradleyGina Sue Bradley
17:49 31 Jan 25
John is invaluable. Navigating insurance is difficult at best, but he made it simple every step of the way when my Mom... retired and EVERTYHING was changing. He explained our options AND found her the best deal. He also always responds to questions!read more
Susan RuckerSusan Rucker
15:40 31 Jan 25
John Claeys with the Claeys Group Insurance Services has been extremely helpful with my freshly-retired change of... insurance. He has extensive knowledge and the gift of explanation. I appreciate so much the time and headaches he saves me!read more
Karl WilsonKarl Wilson
02:54 30 Jan 25
Very helpful as I transitioned to Medicare. Clearly explained available options. I never felt any pressure to make... decisions before I had all the necessary informationI highly recommend John.read more
Sharon WilsonSharon Wilson
02:53 30 Jan 25
John was informative, helpful and caring. His advice was just what we needed as we started on our Medicare journey. We... would highly recommend his services.read more
Karen RileyKaren Riley
20:11 29 Jan 25
We started using John's services 10 years ago. He has proven to be very knowledgeable about the ever-changing health... care rules. He made the nightmare of choosing the right medicare and supplement policy a breeze. The best part is that he doesn't disappear after you decide on a policy. He's there for the long haul and ready to help you with issues that may arise. Highly recommend his services.read more
DonnaDonna
18:29 29 Jan 25
I am so grateful I used the Claeys Group for my Medicare questions and navigation. He was so informative and helpful!!... Thanks again!!read more
KK's EmbroideryKK's Embroidery
17:10 29 Jan 25
John came to my business and was very helpful and friendly. Answered all my questions and helped me discover the right... options for my Medicare needs.Would very much recommend him to help navigating the process for signing up!read more
Thomas HaysThomas Hays
00:44 14 Nov 24
My wife and I continue to enjoy John and his knowledge as he helps us change and work on our policies for 2025! Thanks... John!read more
Wayne BellWayne Bell
14:31 30 Oct 24
John has been my insurance guy for years. He is not only very professional, but a great guy. Very friendly and very... knowledgeable in what he does. I would recommend John to everyone.read more
js_loader

by:

Leave a Reply