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Six questions to ask before choosing a Medicare Advantage plan

Posted June 08, 2022 by Sue Crawford, Vice President, Sales and Market Development

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Whether you’re just turning 65 and newly eligible for Medicare or you’re simply looking to enhance your current Medicare coverage, there are key things to consider when weighing your options for a Medicare Advantage plan.

Medicare Advantage plans offer everything that original Medicare covers, but adds extra benefits and services. Those extras could include coverage for dental, vision, hearing aids, over-the-counter items, gym memberships, rides to your doctor and much more. 

It’s true Medicare Advantage plans help consumers make the most of their Medicare dollar, but there are many factors that can influence which Medicare Advantage plan you choose. So before enrolling in a Medicare Advantage plan, make sure to ask these six questions:

What is my share of the costs for medical services and supplies?

For a yearly cost estimate, a good place to start is with the monthly premium, deductible and out-of-pocket maximum. The good news is none of SummaCare’s plans have a deductible, which is what you’d pay out of pocket before insurance kicks in. The out-of-pocket maximum is the most you will pay for medical services throughout the year and once you reach that limit, you’ll pay nothing for covered services for the rest of the year.

In addition, determine how often you’ll be refilling prescriptions and scheduling doctor visits, and then add in your copays and drug deductible costs.

Are the doctors and hospitals I prefer to use in the plan’s network?

If you have a primary care doctor or specialists you have been seeing and want to continue seeing them, make sure they are in the network of the Medicare Advantage plan you are selecting. It also doesn’t hurt to ask your doctor or other providers if they are in the network you are considering.

SummaCare offers a vast network of more than 22,000 providers and 75 hospitals throughout northern Ohio, including Summa Health, Cleveland Clinic and University Hospitals. You can check SummaCare’s online provider search to look for a preferred doctor or hospital.

If your providers aren't included, find out if the plan offers out-of-network coverage.

What additional coverage and benefits does the plan cover?

All Medicare Advantage plans cover what original Medicare covers, so you’ll first need to consider what type of coverage you need in addition to the original Medicare coverage.

SummaCare’s Medicare Advantage plans can offer dental, vision, hearing, prescription drug coverage and health-care perks, such as fitness coverage and medical transportation, at no additional cost. Start by making a checklist for the services for which you need coverage and compare plans to find out which plan best suits your needs.

Are the drugs I normally take covered under the plan?

Insurance companies that offer Medicare Advantage plans will help you determine if your medications are in its formulary (list of drugs covered). At SummaCare, you can search online using our Prescription Drug Finder. In addition, check to see if your pharmacy is in network and whether the plan offers prescriptions by mail.

Most of SummaCare’s Medicare Advantage plans include Medicare Part D prescription drug coverage at no additional cost.

What is the quality rating of the plan?

A great place to start is by reviewing Medicare’s star ratings to help you choose a high-quality plan. 

Each year, the Centers for Medicare and Medicaid release a star rating for each Medicare Advantage plan based on more than 40 rigorous quality measures to help people selecting Medicare compare plans. Plans are rated on a one to five scale, with five stars representing the best performance and one star the worst. The number of stars a plan has reflects measures such as, member satisfaction, care coordination and the quality of care delivered.

SummaCare’s 2022 Medicare Advantage plans earned a 4.5 star rating, which underscores its hard work, dedication and commitment to providing high-quality service to members.

Am I covered while traveling?

You may travel during the year for vacation, to visit family or you’re a “snowbird.” If so, you’ll want to make sure the plan has nationwide and even worldwide coverage. Many plans cover prescriptions, emergency and urgent care while traveling.

It’s definitely a lot to consider but taking all these factors into account can help you choose the coverage that best suits your needs and budget.

Best of all, if your needs change, so can your plan during the Medicare Advantage Annual Enrollment Period, which runs from October 15 to December 7 of each year.

Finding the right plan can feel overwhelming. Let SummaCare help. Learn more about SummaCare’s Medicare Advantage plans, compare plans or enroll at, or by calling 888.469.1010. You also can join us at a FREE informational seminar.


H3660_22_321_M Accepted 05182022