# March, 12, 2020

How to Compare Medicare Advantage Plans

Medicare Advantage (MA) plans are available to all Medicare beneficiaries who are enrolled in both Parts A and B (Original Medicare). Also known as Medicare Part C, around one-third of all Medicare enrollees have made the switch to an MA plan. This post describes how to compare Medicare Advantage plans so you get the best coverage for your unique needs and budget.

What Is a Medicare Advantage Plan?

Medicare Advantage plans offer the same coverage as Original Medicare but they’re managed by private insurers instead of the federal government. Although every MA plan must provide the same level of coverage as Medicare Part B, plans may also offer additional services. Since the plans are provided by private insurers, coverage and costs vary.

Minimum eligibility for Medicare Part C is to be enrolled in both Parts A and B and to live in the service area covered by the MA plan. Some plans have additional requirements; review these carefully.

Please note that enrollment in a Medicare Advantage plan does not mean you no longer have to pay the Medicare Part B monthly premium.

What Are the Plan’s Benefits?

Most Medicare Advantage plans provide benefits not covered by Original Medicare. The most common is prescription drug coverage. Other benefits may include:

  • Dental care, such as routine cleanings
  • Vision care, such as eye exams and corrective lenses
  • Hearing benefits, such as exams and hearing aids
  • Health and wellness programs

When you compare Medicare Advantage plans, look at how they provide these benefits. This includes costs as well as frequency. If you consider only price, you may not notice details, such as one plan pays for hearing aids every year while another makes you wait 3 years.

Compare Medicare Advantage plans

How Much Does the Plan Cost?

When considering cost, many beneficiaries fail to look past the monthly premium. Unfortunately, a low monthly premium often hides higher out-of-pocket costs elsewhere. Or, a plan with a higher premium but more robust coverage may be the better buy if it means you don’t need ancillary policies for vision and dental.

There are four main out-of-pocket costs to consider with a Medicare Advantage plan:

  • Monthly premium
  • Co-payments and/or co-insurance
  • Yearly deductible
  • Yearly out-of-pocket maximum

That last item, out-of-pocket maximum, is something you don’t get with Original Medicare. In 2020, the out-of-pocket maximum for Medicare Advantage is $6,700. However, that is just the minimum requirement. Plans often have a lower out-of-pocket max.

Out-of-pocket costs that count toward your yearly maximum include deductibles, co-insurance, and co-payments for all services covered by Medicare Parts A and B.

Types of Medicare Advantage Plans

There are four basic types of Medicare Advantage plans. They include:

  • Health Maintenance Organization: More commonly known as an HMO, this is the most common type of MA plan. Most HMOs require members to choose a primary care doctor who coordinates their care. There is also usually a provider network. Care received outside this network is rarely covered. Also, most HMOs require a referral to see a specialist.
  • Preferred Provider Organization: Also known as a PPO, these plans also usually have a network. However, plan members may choose any provider, they just have to pay a higher out-of-pocket cost. You also don’t usually need a referral to visit a specialist.
  • Private Fee-for-Service: Also known as a PFFS plan, members do not have to choose a primary care doctor nor get a referral to visit a specialist. However, you need to make sure the provider accepts your PFFS plan. Even providers who accept Medicare may not work with a PFFS plan.
  • Special Needs Plan: Also known as SNPs, these plans are for Medicare beneficiaries who meet certain requirements, which vary according to the plan. Most SNPs are geared toward people who have specific medical conditions, such as diabetes.

Answer questions to compare Medicare Advantage plans

Questions to Answer to Compare Medicare Advantage Plans

Answer the following questions to help you compare Medicare Advantage plans.

What do you get for your monthly premium?

Monthly premiums vary widely for Medicare Advantage plans, with some as low as $0. But you still have your Medicare Part B premium as well as the co-pays and deductible for your MA plan. So, look carefully at the benefits it offers.

What additional benefits does the plan offer?

At a minimum, you want an MA plan that covers prescription drugs. But many areas offer multiple plan options, which means insurers become more generous with their additional benefits. Many people don’t realize that Original Medicare doesn’t cover dental, vision, or hearing. An MA plan that provides these benefits could save you money.

Does the plan’s network include your providers?

Most MA plans have a provider network that includes doctors, hospitals, labs, DME providers, nursing homes – basically any entity you may rely on for healthcare. If your provider is not part of the network, you either need to change to a provider who does accept your plan or find a new plan – or be prepared to pay 100 percent of your costs.

Does the drug formulary cover your prescriptions?

All prescription drug plans – whether through an MA or Medicare Part D plan – have a drug formulary. Simply put, this is the list of prescription medications covered by the plan. If any of your prescriptions aren’t on it, you’ll have to pay the cost of those medications out-of-pocket.

How much is the annual deductible?

The deductible is the amount you have to pay out-of-pocket before your plan starts paying. It does not include your monthly premium. Make sure the deductible is an amount you’re comfortable paying.

What is the maximum out-of-pocket limit?

This is particularly important if you expect to have high medical costs. Once you reach that out-of-pocket max, your plan covers 100 percent of your costs for the rest of the year (assuming those services are covered by Medicare).

What is the plan’s star rating?

The Medicare 5-Star Rating System rates every Medicare Advantage and Part D plan based on a number of metrics. Five stars indicates the best plans. Anything below 3 stars is considered “poor.”

To assign scores, Medicare considers plan member feedback, the program’s own monitoring system, and information it receives from clinicians and the plan itself. The Medicare plan finder tags 5-star plans with a special icon: A number 5 inside a star, topped by a yellow triangle.

You can also compare Medicare Advantage plans with our Find a Plan tool. Just enter your location and estimated start date to begin. It’s free and there’s no obligation to purchase a plan.

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The MedicareUSA website is operated by HealthPlanOne, LLC a licensed health insurance agency based in Connecticut; in California d/b/a HPOne Insurance Agency, license #OF30784. HealthPlanOne, is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

Medicare supplement plans are not connected with or endorsed by the U.S. Government or the federal Medicare program.

The Centers for Medicare and Medicaid Services (CMS) does not review or approve Medicare Supplement plan information.

Other Pharmacies are available in the plans' networks.

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Last Updated 12/21/2018