Choosing A Medicare Advantage Plan When You Have Preexisting Conditions

If you have a preexisting medical condition, the good news is that your condition will not inhibit you from securing a Medicare Advantage plan. However, your condition should play a part in your decision on which plan to choose. Given that all advantage plans are not the same, every plan may not align with your preferred care plan for your condition, so you want to ensure you make the proper selection.

Provider Network

Pay close attention to the provider network included with the plan. Given your health status, you likely have a team of healthcare professionals that you entrust your care to. Ideally, you want to select a program that will allow you to continue to visit these providers. Remember, if your current providers are not included in your plan, you will have to pay out-of-network costs per visit, so double-check. 

Out-of-Pocket Maximums

Copay or coinsurance costs are important, but if you have preexisting conditions, the out-of-pocket costs for an advantage plan are also significant, as this is the total amount you are required to pay before the insurance plan provides 100 percent coverage. For people with preexisting conditions, policies with lower maximums are often a wiser financial choice, as you are more likely to reach this threshold with regular visits to the doctor. 

Prescription Coverage

If your preexisting condition requires medication treatment or therapy, review the formulary for any advantage plan you select before making a decision. Not every program offers covered access to the same prescription medications. Should you choose a plan that does not cover your treatment, you may be forced to change drugs, which may or may not be best for your condition. Speak with your provider and review the plan details for help.

Referral Criteria

A primary care provider can manage some preexisting conditions; however, there are some medical conditions that require access to a specialist. Learning about the advantage plans referral criteria up front is a good idea. For instance, some policies do not require pre-authorization for a specialist visit, but some may require a visit with your provider for a specialist referral. There may not be much difference in costs in this area, but there will be a difference in the length of time it takes to see a specialist depending on the criteria. 

Remember the above factors to ensure you choose a plan that meets all your health needs. Should you have additional questions, do not hesitate to reach out for further assistance.