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.
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.
Most Medicare Advantage plans provide benefits not covered by Original Medicare. The most common is prescription drug coverage. Other benefits may include:
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.
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:
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.
There are four basic types of Medicare Advantage plans. They include:
Answer the following questions to help you compare Medicare Advantage plans.
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.
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.
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.
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.
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.
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).
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.
Since 2015, Kolt Legette has helped clients navigate the often-confusing world of insurance. His number one goal is protecting the medical and financial wellbeing of every person he speaks with, whether they choose to buy insurance or not. Kolt loves representing the best brands in medical insurance as it allows him to provide side-by-side comparisons for his clients. This allows the client to decide which company works best for them. By putting the needs of the client above everything else, Kolt helps real people find affordable health insurance solutions for their most pressing healthcare needs. With his belief that peace of mind is priceless, Kolt's goal in every interaction is to make sure every person he speaks to leaves with the peace of mind they rightfully deserve.
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.
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Other Pharmacies are available in the plans' networks.
Last Updated 12/21/2018