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Most Important Medicare Advantage Plan Documents To Review

Red Numeral ThreeDon’t think of enrolling in Medicare Advantage without reviewing these plan documents

If you are considering joining a Medicare Advantage plan you have to cut through all the noise and get the hard data. It makes no difference whether you are new to Medicare or have been on Medicare for some time.

Even if you have been happy with your current Medicare Advantage plan don’t assume that the benefits will necessarily stay the same. Each year it is more important than ever that you do your homework and get it right the first time.

There are 3 Medicare plan documents specific to each plan that, if you review them carefully, will allow you to be sure to enroll in the best plan for your circumstances.

If you choose poorly you will have to live with it until next year or take advantage of the Dis-enrollment Period that takes place from January 1st through February 14th and return to original Medicare.

Review these plan documents first

Forget the feel-good commercials, the promise of a friendly nurse line or a free gym membership. Things are getting serious and you should consider an Advantage plan for two reasons; to protect your health and to conserve your wealth. Get your hands on these three things and you will do just that.

  1. The Summary of Benefits. This is where you will find the hard facts as to what the plan will cover and what it will not cover. Don’t let a sales agent review the “benefits overview or benefits at a glance” and consider that sufficient. It’s not. There is a Summary of benefits for a reason and you should spend some time with it. Understanding this document will eliminate any surprises in the future. Joining a Medicare Advantage without reviewing the Summary of Benefits is like buying a car without asking about the engine.
  2. The Part D Plan Formulary. Not all Medicare Advantage plans include Part D but most do. If you are enrolling in an Advantage plan don’t gloss over this document. Don’t get hooked on, ” … and there’s no deductible and look at those low co-pays…” Not having a deductible is great and low co-pays are icing on the cake but if your drugs aren’t covered… what do you have? Something that’s going to leave you with a lighter bank account! Ask if you drugs are included and see it in writing. The key to understanding a plan’s benefits resides in the Part D formulary.
  3. The Provider Directory. Given the changes that have taken place with Medicare Advantage plans over the years there’s a very good chance that you are comparing network-based plans or have a PFFS plan with an available network. Don’t stop after you find out that your primary care provider is in-network. Check your specialists. Probably more important than your doctor is which hospitals are in-network. Given the structure of Medicare Advantage plans you will incur a much greater cost if you are hospitalized than you will with doctor visit co-pays. If you are considering staying in the same plan don’t assume that there are no changes in the provider network. Do your homework.

When comparing Advantage plan consider these three things to be the most important. Getting a low premium or free plan is not a benefit if you drugs are not covered, your providers are not in-network and you’ve overlooked important details contained in the Summary of Benefits.


Choosing Medicare Advantage plan doesn’t have to be difficult. The Annual Enrollment Period is your time to compare several plans. Follow this road map and you will have peace of mind that you have chosen the best Medicare Advantage plan for your circumstances.

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  1. You should be aware that for certain life-saving procedures done at only specific facilities such as MD Anderson Cancer Center in Houston, your Medicare Advantage plan is NOT ACCEPTED. MD Anderson does not except any medicare replacement policies, as may be true of many specialty centers across the nation. Regular medicare plus a supplemental would work, but the medicare replacement policies do not work. No coverage, no care for you, and too bad, they may just let you die rather than get the life-saving procedure.

  2. Mary, Interesting comment. Medicare Advantage plans are not accepted by many providers. If they are network-based plans, they, by definition, will not be accepted by all providers. If they are PFFS plans, providers can choose to accept them or not and they can do so on a visit by visit basis. I would recommend that anyone with similar concerns to yours, exercise their freedom to choose the type of plan they believe will be best for them.

  3. Geraldine Nichols

    I was just looking online to see if M.D. Anderson accepted MEDICARE.
    I received quite a shocker this past Friday. I am a 12 year breast cancer survivor and lost my job last February along with, of course, my medical insurance. I had called different departments at M.D. Anderson for a month or more asking about how I can handle my yearly check up, help, or payments, or whatever. I was informed that because I have no medical insurance, I must pay upfront……….duh… no job…… money to pay. Bottom line, I was told “You are a survivor, YOU NEED YOUR YEARLY CHECK UPS…..but we cannot help you here”. So I will miss this check up…was just checking to see if I make it to retirement, if I can continue being seen???? I told whomever I spoke to that they should want to see me purely to document the effectiveness of the treatment and continued survivorship and PLEASE LET ME MAKE PAYMENTS for the check up……NO DICE. Over the years MDA has collected thousand from me. Lose your insurance and you might as well die for all they care…………………I am truly disappointed in them, shocked really. Enraged could also describe how I feel. Anyone else have a similar experience with MDA?????

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