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How to Compare Medicare Advantage Plans


The popularity of Medicare Advantage plans is rising swiftly, and for good reason. Plans for Medicare Advantage provide many of the same benefits as Original Medicare. How to pick the best Medicare Advantage plan for you is explained here.

Nobody’s needs for medical care are the same as another person’s, either. This is why picking a health plan is such a subjective choice.

the positive news There are numerous medical coverage alternatives available when selecting a Medicare Advantage plan. What’s the bad news? You have several choices. However, that’s where we step in. For you to select the Medicare Advantage plan that best suits your needs, we are here to assist you to learn everything you need to know about them.

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What is a Medicare Advantage plan? 

Let’s start at the beginning: Original Medicare (Medicare Part A and Medicare Part B), which is managed by the government, is an alternative to Medicare Advantage plans. On the other hand, commercial insurance firms that work with Medicare can provide Medicare Advantage. Medicare Part C is another name for it.

According to Caitlin Donovan, a representative for the National Patient Advocate Foundation, “It’s beneficial to think about Medicare Advantage as a mix [between Medicare and commercial health insurance].”

Every Medicare Advantage plan is required to go by a set of guidelines established by Medicare. For instance, they are all required by law to offer coverage that is at least as comprehensive as Original Medicare. They stand out because the majority of policies offer much greater coverage than that.

Numerous Medicare Advantage plans offer coverage for hearing aids, regular eye, and dental treatment, as well as health and wellness initiatives (like gym memberships). They frequently also cover prescription medicines. You must purchase a separate prescription drug coverage plan if you have Original Medicare (Medicare Part D).

Additionally, Medicare Advantage plans have an annual out-of-pocket cap, which is a crucial distinction. Before the plan would fully cover your care, you would need to spend no more than that in a single year. There is no cap on your out-of-pocket expenses with Original Medicare.

But enrolling in a Medicare Advantage plan has certain disadvantages. According to Donovan, you might need to use in-network doctors, acquire referrals to see specialists or get prior authorizations for particular types of care.

Medicare Advantage eligibility requirements are as follows:

  • Being a citizen or having a valid visa to enter the country.
  • Medicare Parts A and B are present
  • Reside in the Medicare Advantage service region that you are considering

What are the different types of Medicare Advantage plans? 

Medicare Advantage programs come in a variety of varieties. Each has different advantages to offer:

Health Maintenance Organization (HMO) plans: HMO plans typically demand that patients receive care from hospitals and providers that are a part of the network. However, there are several exceptions, including temporary out-of-area dialysis and emergency care as well as out-of-area urgent care.

If you join an HMO, you’ll probably need to select a primary care physician, and you’ll probably need the recommendation to see a specialist.

Preferred Provider Organization (PPO) plans: With a PPO plan, you can get out-of-network care for a higher cost while paying less for care from in-network doctors and hospitals. You’ll always have access to urgent and emergency treatment. You won’t have to pick a primary care physician, and the majority of the time, you won’t need a referral to see a specialist.

Private Fee-for-Service (PFFS) plans: Under a PFFS, the plan determines both the amount it will pay hospitals and healthcare providers as well as the amount you will pay for services. While some plans have no restrictions on your choice of physician or facility, others have a provider network.

You’ll always be treated if you seek emergency or urgent care, though. Additionally, you won’t need to select a primary care physician or ask experts for recommendations.

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If prescription drug coverage is crucial to you, always be sure it is included in any of these plan types. Many, but not all, do.

Then, verify that your specific medication is covered by the plan by looking at the formulary or list of approved prescription drugs. People with Medicare Advantage often do not have access to separate Medicare Part D plans, which cover prescription drugs.

Special Needs Plans (SNPs): SNPs are only available to a certain group of individuals, such as: 

  • Those suffering from specific illnesses or conditions (ESRD, HIV/AIDS, as well as several autoimmune, lung, and neurological ailments)
  • Individuals who reside in a facility such as a nursing home or another hospital
  • Those who qualify for Medicaid and Medicare 

Out-of-network services are covered by some SNPs but not by others. You’ll need to have a primary care physician or another care coordinator for the majority of them, and you frequently need a referral to see a specialist. All SNPs must offer coverage for prescription medications.

What’s the best way to compare Medicare Advantage plans? 

Medicare-approved commercial insurance providers provide Medicare Advantage plans, and as a result, each one may have a different price and set of benefits. Each plan may have unique out-of-pocket expenses and requirements, such as when a specialist referral is required.

The Kaiser Family Foundation estimates that there are almost 4,000 Medicare Advantage plans offered in the United States, though not all of them are accessible everywhere. According to the KFF, you can choose from 39 different Medicare Advantage plans on average, which is the most options in more than ten years.

What to consider while contrasting the best Medicare Advantage plans is as follows:

  • Your monthly premium payment for your Medicare Advantage plan is known as a monthly premium. Although the cost of Medicare Advantage plans might vary, they frequently have the same premium as Medicare Part B. (The Medicare Part B base premium, is expected to be $170.10 per month in 2022.)

  • Annual deductibles: This is the amount you’ll need to pay out-of-pocket for medical expenses or prescription prescriptions before your insurance starts to pay. You should feel at ease spending this sum for the package you choose.

  • Initial protection and financial restrictions: In contrast to Original Medicare, every Medicare Advantage plan has an annual maximum spending cap. Once you’ve spent up to this total, which includes the deductible, the Medicare Advantage plan will cover all of your covered medical expenses for the remainder of the year.

  • Additional advantages: Some Medicare Advantage plans offer extra benefits including free or heavily discounted wellness programs like gym memberships, as well as routine vision, hearing, and dental treatment.

  • Each plan will have a list of medications that are covered in terms of prescription drug coverage. If you need prescription medications, you might want to think about choosing a plan that does.

  • Network of providers: If there are any doctors you visit frequently, investigate if your Advantage plan’s network includes them. Visits to them might not be covered if they aren’t. (Remember that your provider and pharmacy networks are subject to change at any time; your Medicare plan will notify you if this occurs.)

  • Each Medicare Advantage plan is given a star rating, ranging from 1 to 5. This is one technique to assess the quality of each plan.


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Which Medicare Advantage plan is best? 

Since everyone is unique, you must take into account your health requirements, financial situation, chosen medical professionals, and prescription pharmaceutical needs. The plan that works best for you could not be the greatest for your partner, other family members, or friends.

A plan’s rates, features, and provider networks can change each year, so one that worked for you two years ago might not work for you now.

Doing a small healthcare audit each year is crucial, especially the year you become eligible for Medicare, according to Donovan.

Spending some time now comparing Medicare Advantage plans could result in significant financial savings down the road.

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