Five Tips for Making the Most of Your Medicare Advantage Plan in 2012

January 23, 2012

As Medicare beneficiaries set out to achieve their New Year’s resolutions this month, they should not leave their health care coverage off the list. For the more than 12 million beneficiaries enrolled in a Medicare Advantage plan, resolving to make the most of their coverage could result in improved health and more money in their pockets in 2012.

“The start of a new year is the perfect time to take stock of the coverage and benefits available to you through your Medicare Advantage plan,” said Dr. Rhonda Randall, chief medical officer of UnitedHealthcare Medicare & Retirement. “Many Medicare beneficiaries are pleasantly surprised when they discover all the ways their plan can help them stay healthy and improve their quality of life.”

Medicare Advantage plans are an alternative to Original Medicare. Offered by private insurers like UnitedHealthcare, the plans combine Medicare Part A – hospitalization coverage – and Part B – coverage for routine doctor visits – into one plan that often includes additional benefits and Part D prescription drug coverage.

With more than 9 million members enrolled in its Medicare health and prescription drug plans, UnitedHealthcare has been serving the Medicare market for three decades. Its Medicare & Retirement business is the nation’s largest dedicated to meeting the health and well-being needs of seniors and other beneficiaries.

According to Randall, the following tips can help Medicare Advantage enrollees maximize their coverage in 2012.

1. Leverage the plan’s additional benefits to stay healthy. Medicare Advantage plans are designed to do more than just help beneficiaries when they are sick. The plans cover all of the preventive services covered by Original Medicare, such as certain cancer screenings and an annual wellness check-up, usually at no additional out-of-pocket cost to the member. These types of services are key to catching health problems early, before they have become serious.

In addition to all of the services covered under Original Medicare, many Medicare Advantage plans provide additional benefits that can help beneficiaries maintain or enhance their health. Wellness programs, gym memberships, disease management programs and 24/7 access to registered nurses are examples of the benefits and services available with many Medicare Advantage plans.

Beneficiaries should take some time to learn about the extra programs and services their plan offers and determine which ones fit into their overall health and wellness plan. Considering the savings and health benefits that could be realized, this is time well spent.

2. Take advantage of cost-savings on prescription drugs. Beneficiaries enrolled in a Medicare Advantage plan that includes drug coverage should check their plan details to see if they could save money on their prescriptions.

Mail-order pharmacy benefits can be a great way to save not only money but also a trip to the pharmacy. Some mail-order pharmacy services offer the convenience of ordering a three-month supply of drugs that are delivered to the member’s home for a lower cost than purchasing the same quantity of drugs at a retail location. Some plans have dropped the co-pay to $0 for select drugs when purchased from the plan’s preferred mail-order pharmacy.

Beneficiaries who prefer to visit a pharmacy to get their drugs should check to see if their plan offers any programs to help members save additional money on their prescriptions. For example, UnitedHealthcare’s Pharmacy Saver program reduces members’ out-of-pocket costs on hundreds of generic prescription medications when purchased at pharmacies participating in the program.

Switching to generic or lower-tier drugs is another step that could save beneficiaries a significant amount of money. The majority of Medicare Advantage plans that include a prescription drug benefit cover most generic drugs for very low or no additional cost to the member. Prescription drugs are typically sorted into several tiers on the plan’s formulary, or approved drug list, with drugs on lower tiers generally costing less than drugs on higher tiers. Beneficiaries should review their plan’s formulary and check with their doctor and plan to determine if a drug on a lower tier might be suitable to treat their condition.

3. Understand the plan’s care provider network, and stay in network as much as possible. Most Medicare Advantage plans work with a network of doctors and pharmacies to coordinate the care that their members receive. In addition, private insurers negotiate with doctors and pharmacies to offer special pricing, which translates into lower costs for members. Whenever possible, Medicare beneficiaries should visit in-network doctors and pick up their drugs from in-network pharmacies to help save money.

Some Medicare Advantage plans allow members to see out-of-network doctors, but the price of the services provided is usually higher. And some plans do not cover services provided by out-of-network doctors, so it is important for beneficiaries to understand their plan’s policies before seeking care.

4. Look for extra plan discounts on every-day health care items and services. Medicare Advantage enrollees can rack up valuable savings by taking advantage of discounts on things they already use or need, such as vitamins, hearing aids and alternative medicine services such as acupuncture. For example, in most regions of the country, members enrolled in UnitedHealthcare’s Medicare Advantage plans can access high-tech, custom-programmed hearing devices either for a low copayment or at a discounted price. Because Original Medicare does not cover the substantial cost of hearing devices, this feature could potentially save UnitedHealthcare members thousands of dollars.

Beneficiaries should review their plan materials to familiarize themselves with the discounts and other offers available to them and then make sure they remember those discounts every time they purchase the item or service.

5. Plan yearly health care expenses with the out-of-pocket maximum in mind. Unlike Original Medicare, Medicare Advantage plans are required to cap their members’ annual out-of-pocket expenses. In 2012, the maximum amount a Medicare Advantage enrollee can be asked to pay out of pocket for in-network medical services is $6,700. Some plans set their out-of-pocket maximum at lower levels. Prescription drug costs, such as co-pays, are not included when calculating a member’s progress toward the out-of-pocket maximum.

Once a beneficiary has reached the out-of-pocket maximum set by his or her plan, all additional costs for Medicare-covered services for the remainder of the year are 100-percent covered. This cap on health care costs can give beneficiaries peace of mind. In the event of an unexpected illness or hospitalization, knowing the expenses are limited by the plan’s out-of-pocket maximum can be comforting. The out-of-pocket limit can also be a helpful number to keep in mind for beneficiaries who are planning to undergo major medical procedures in the coming year.

By taking a proactive approach to their health care coverage, beneficiaries can lower their costs and enjoy enhanced health and well-being in 2012. For ongoing updates, tips and reminders about Medicare, beneficiaries can visit, “like” Medicare Made Clear on Facebook or follow @MedicareClear on Twitter.

More information is available at and

About UnitedHealthcare
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers and Medicare and Medicaid beneficiaries, and contracts directly with more than 650,000 physicians and care professionals and 5,000 hospitals nationwide. UnitedHealthcare serves more than 38 million people and is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage organization with a Medicare contract.  

Be the First to Know

Stay up-to-the-minute on the latest headlines from UnitedHealth Group.