Community Focus

7 Things to Know Before Choosing a Medicare Advantage Plan

01 October 2023

Knowing where to start when choosing a Medicare Advantage plan can be challenging. Whether it’s understanding common terms or how to compare plan differences, use the tips below to help figure out which plan is right for you.


1) Consider Your Current Medical Conditions

Consider your current health conditions (both physical and mental), prescriptions, and what you may need to manage your overall health. Health issues and diseases that lead to regular doctor visits and frequent treatment require a plan that offers a variety of care options, including in-person and virtual visits. 

Have you thought about mental health? In the wake of the pandemic, mental health issues continue to rise across the country. You might want to look into a plan with behavioral health offerings, as you never know if you will need support now or later in life.


2) Compare Plan Costs 

When comparing plans, it’s important to look at the different costs. Here’s some areas to consider:

  • Copays: The amount you are responsible for paying a healthcare provider for their service.

  • Insurance premiums: The monthly fee you will pay for coverage. 

  • Deductible: The amount you pay for covered healthcare services before your plan begins to pay the costs.


3) What are Your Prescription Needs?

Taking into consideration current medical conditions and prescription needs, it’s important to know if the Medicare Advantage plan you choose covers your necessary drugs and therapies. Every health plan must include a list of prescriptions that are covered, also known as a “formulary,” which can be found in the summary of benefits and coverage. If you’re having trouble determining if your medications will be covered, call the plan’s support line to talk to an insurance expert.


4) Is the Provider Network Broad or Narrow? 

Having a physician who truly knows and cares for you makes a difference when managing your health. When looking at plan options, check if visits to your preferred healthcare providers are covered. Dr. Victoria Leigh, a Providence primary care physician, explains “My patients often ask me for information regarding their plans. The most important thing I tell my patients to do is write down the list of doctors that they most want to keep seeing, the facilities/hospitals where they want to maintain care, and any medical conditions and medications that could impact the type of plan they select. From there, you can inquire about available plan options that fit your priorities.” 

Be aware! Some plans have a narrow network with specific providers. But with Providence, your network goes beyond the Providence name, giving you access to thousands of local providers. Find out if your preferred provider is in network through the Providence Health Assurance Medicare Advantage Directory Search


5) Don’t Forget About Dental, Hearing & Vision Benefits

Maintaining good dental hygiene, vision, and hearing are also important factors when choosing the Medicare Advantage plan that is right for you, as untreated conditions can lead to further health issues. For example, establishing good oral hygiene isn’t just great for preventing bad breath and gum disease, but it also reduces your risk of dementia, cancer, and other conditions such as stroke and heart disease. Oral health problems affect about 3.5 billion people globally, so, it’s crucial to have regular check-ins with your dentist and a dental hygiene routine. Many of the Providence Medicare Advantage plans have the added benefit of a flex dental card that can be used for any service at a dental clinic. To learn more about your dental coverage options with Providence Medicare Advantage plans, check out our plans here.


6) Are there Unique Plan Offerings to Consider?

No two health plans are the same, with many including services and added perks for members such as health incentives and mental healthcare offerings. For example, Providence Medicare Advantage Plans offers plans that provide membership opportunities to gyms and workout classes and additional care services such as ExpressCare Virtual, a free telehealth offering.


7) Don’t Discount Member Support

When you enroll in a plan, be aware of the member or navigation support provided. Some plans offer on-demand help for navigating benefits, billing, and more. And, if you enroll in a Providence Medicare Advantage plan, you’ll have access to our team of caregivers who are ready to answer your questions and help you navigate your healthcare journey.

As an added benefit to help you during open enrollment, Providence Medicare Advantage Plans offers members access to a team of enrollment experts, who can be reached by calling (503) 574-8416 or by filling out a contact form. If you need additional guidance, we recommend reaching out to a local insurance agent or trusted advisor who will ensure you have all the necessary information on health plan options to make the decision that is best for you. 

You can learn more about Providence Medicare Advantage Plans competitive options here


Disclaimer: Providence Health Assurance is an HMO, HMO‐POS and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Health Assurance depends on contract renewal. You must continue to pay your Medicare Part B premium. 

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