If you are a senior who either wants to possibly change your Medicare Advantage Health Plan or your Medicare Prescription Drug Plan… OR… you want to consider buying one or the other for the first time, now is the time to check out the facts about these plans. Enrollment is open until December 7 after which you will be locked into the plan you now have – and locked out of changing plans – for another year (with only a few exceptions).

There are many Medicare Advantage “all-in-one” health plans which include a prescription drug plan, and all but one are HMO Plans. Most of these plans have no premium required. There is also one approved Medicare Advantage PPO plan available, though it is of questionable value in its new 2015 form. Co-pays and hospital admission fees are usually very low in these plans, sometimes even zero.

With Medicare Advantage HMO Plans here in the Coachella Valley, you will have just three medical groups of doctors and specialists from which to choose your Primary Care Physician (PCP). If you need to see a specialist and obtain a referral from your PCP, you can only be referred to specialists in your PCP’s medical group (not doctors in our area’s other two HMO medical groups). And if you are away from the Coachella Valley, most medical expenditures will be considered “out-of-network” except for true life-threatening occurrences.

Remember, when you enroll in a Medicare Advantage Health Plan (MAPD), you in effect sign over your original Medicare benefits to the medical group of which your PCP is a member. Thus you cannot go to other doctors or have any Medicare benefits to use because they are replaced by your MAPD plan.

Another option for seniors is to have a Medicare Insurance Supplement Plan coupled with a Medicare Prescription Drug Plan (Part D), each of which is purchased separately. This approach offers maximum flexibility and control allowing you to see any doctor or medical facility in the entire United States, as long as they accept Medicare patients.

And after paying the premium for a Plan F Medicare Insurance Supplement to Medicare, you should not have to pay anything for all of your medical care, in or out of the hospital, as long as your medical services are “covered expenses” on the Medicare program. For example, cosmetic surgery for droopy eyelids is not covered by Medicare, and therefore is not covered by any Medicare insurance supplement. You would only have to pay your deductible and co-pays on the Part D Prescription Drug Plan for medications bought at local pharmacies or through the Part D plan’s mail order service.

All of this can be confusing, so it can be of great assistance to contact a knowledgeable licensed health insurance agent who can assist you in making the best decisions for your medical needs and budget.

Bill Robinson has been a licensed agent for 32 years and is owner of Palm Canyon Insurance Agency in Palm Springs. (760) 416.4225