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!

Linda WilliamsLinda Williams
10:08 12 Jul 23
I had a 5 star experience and would recommend him. Always returning my calls promptly, very helpful and informative, listened to what my needs was regarding my Medicare. I truly felt comfortable with John's help to navigate through the maze of Medicare
Cindy KulakCindy Kulak
14:51 18 Jun 23
John is very knowledgable, honest and ethical in helping clients evaluate Medicare options and get enrolled. He made the process extremely easy for myself and my husband.
Leeann MoosLeeann Moos
17:26 06 Apr 23
When I became eligible for Medicare, my phone was constantly under attack from Medicare options sales folk. Since I needed help understanding my options and life is too short to do business with annoying people a little research was in order. Thats how I found John. His other customers seem very pleased with his service and I decided to give him a try. I was NOT disappointed! He did an excellent job for me, is extremely personable and I could not be happier. Thank you John
Rose WrightRose Wright
16:07 05 Apr 23
I am so thankful for the help that Mr. John was able to assist me with medicare information. After being bombarded with letters and phone calls you just need someone who can walk you through the confusion. And after getting all the info and the best plan and benefits for what i needed. I am glad that He was there for me.Thank you so very much,Rose Wright
Steve HenselSteve Hensel
21:08 04 Apr 23
Claeys Group is great to work with. John is truly professional, knowledgeable and makes the entire process flow so much more smoothly than I expected. I would highly recommend him.
Deborah RounsavallDeborah Rounsavall
14:25 07 Mar 23
I changed from my person finance planning group to John for help. Others led me astray. John is very responsive and follows up promptly. Even helped me on the weekend at the end of year to get all my documents in on time so I didn't lose insurance coverage. Explains all the options in a manner that us rookies can understand it. I highly recommend John.
Setella ParksSetella Parks
13:12 07 Mar 23
John's knowledge is invaluable when it comes to navigating the murky water of Medicare plans. He answered all our questions in a manner we could understand and helped us compare benefits between plans, services, and providers readily available in our area. I am so happy we called on him to assist us! He handled EVERYTHING professionally and patiently and has followed up to make sure we are good. Highly recommend his 5 star service!
Sherry JonesSherry Jones
21:01 23 Feb 23
John was recommended by my sister-in-law, who spoke very highly of him. He wrote out the differences between policies and explained it step by step to me so I could understand which policy would be best for my needs. He was professional but also down to earth so I could be at ease. He did this at my bed side which was such a blessing for me. I highly recommend John for your Insurance needs.
19:40 20 Feb 23
We were recommended by friends to call John Claeys for our insurance. He came twice to gather information on what we were looking for and returned with information and details. We are delighted to have John Claeys as our agent and would recommend to our friends and anyone else to call John Claeys today.Tom and Debbie
Joyce SandvikJoyce Sandvik
20:32 30 Aug 22
John Claeys came to our house to talk about all aspects of Medicare. He wrote out some information on a notepad as he talked and answered our questions. He gave us the handwritten notes along with printouts of more information specific to my needs. My husband and I took o a few days to discuss the options. John took a list of my medications and researched all the available prescription insurance policies for me. He narrowed it down to the best policy (best prescription prices) for me. It was so easy and I felt confident I was getting exactly what I need when I turn 65. Every September, he will research prescription policies from my updated list of medications to find the best policy for my needs. Thanks to John Claeys for making this transition extremely easy and effortless.
Marilyn ScottMarilyn Scott
09:35 23 Jul 22
John enrolled my husband into Medicare 4 years ago. I knew then I wanted him to help me with my Medicare when it was my time to enroll. John helped me recently. He is very knowledgeable, humble and so patient. He made sure I had the best plan for me. He genuinely cares about his clients. He is the best insurance consultant! I highly recommend John for your Medicare needs!!
James MartinJames Martin
20:31 20 Jun 22
John did a great job of providing many options for my insurance. He is very thorough.
Judy MarkmanJudy Markman
17:02 20 Jun 22
John goes above and beyond to find the best insurance to fit your needs at an affordable price. I definitely recommend!
Dave LemingDave Leming
16:56 20 Jun 22
John was referred to my wife and I as we began to transition to use Medicare as our insurance options. He was very knowlegeable about all things related to government programs and supplemental options as well. I would strongly recommend his services to anyone requiring such support.
Ed HareEd Hare
14:16 08 Jun 22
John was recommended to us by a friend as we were turning 65 and having to make decisions on our medicare and advantage plan choices.John was thorough, informed, patient and engaged in helping us wade through all the minutia we were receiving to package the best set of programs for our future healthcare needs.We are happy and confident as healthcare needs arise having John at our side.Debi and Ed Hare
Julie SimpsonJulie Simpson
02:36 14 May 22
We selected an awesome advisor in John Claeys! John was dedicated to our needs in counseling our new Insurance choices with Medicare. He is sincere in getting his customers into the program that is best for their situation. John was sincere in explaining the process and we are happy to refer him to others! Steve and Julie Simpson
Sherry HilliardSherry Hilliard
16:55 18 Feb 22
John was extremely helpful when I had to select my Medicare supplemental policy. He is very knowledgeable in the various insurance products. I would recommend John to anyone needing insurance, and in fact, I have recommended him to several of my friends.
Margie SmithMargie Smith
01:08 16 Feb 22
Highly recommend Claeys Group Ins Service, John has assisted with my Medicare supplement and RX choices for past couple years. He is very knowledgeable of the various companies and policies available. Saved money and introduced me with a 5star company.
16:56 10 Feb 22
John came to my house and explained the process of signing up to Medicare in an understandable way. He gave me the steps to take and assisted in the planning. With his help, I got it done. Before he came, it all seemed overwhelming. He's so genuinely nice, and I felt like I had known him for a long time. I highly recommend him, and in fact, already have recommended him to friends and family.
Rebecca NelsonRebecca Nelson
21:00 04 Feb 22
John Claeys is a great individual to work with you on insurance needs. He searched out the best policy and an affordable one that I could handle. He researches every year to be sure I’m getting the most for my money! Highly recommend this group.
Dorys GardensDorys Gardens
12:20 23 Jan 22
John was so pleasant to work with. He explained everything clearly and did not pressure me to make a decision one way or the other. He shopped for the best customized drug plan which will be saving me money in the long run. I highly recommend letting him guide you through the medicare process.

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