Compare Medicare Advantage Plans

When you become eligible for Medicare, you’ll have a couple of options on how you’d like to receive your Medicare—Original Medicare or Medicare Advantage. Medicare Advantage Plans will typically have lower costs than Original Medicare and are required to provide an annual maximum on how much a beneficiary can spend on medical expenses.

Medicare Advantage is also known as Part C of Medicare. These plans are provided by private insurance companies and regulated by the Centers for Medicare & Medicaid Services (CMS).  They combine your benefits from Medicare Part A, Part B, and, in most cases, Part D into one comprehensive private plan. While these plans must cover the same benefits as well or better than Original Medicare, they may also include additional benefits such as vision and dental coverage.

You must meet the following requirements to be eligible for a Medicare Advantage Plan:

• Have active Medicare Parts A and B
• Live in the plan’s service area

Types of Medicare Advantage Plans

There are several options to consider when choosing a Medicare Part C program.

Health Maintenance Organization (HMO)

HMO plans focus on maintaining your health, but they have more restrictions than other options. You’ll choose a primary care physician to manage your healthcare with an HMO plan. They will coordinate all medical services and will refer you to specialists as needed. These plans require you to use in-network doctors unless it’s an emergency situation.

Health Maintenance Organization – Point of Service (HMO-POS)

These plans work precisely the same as a traditional HMO, with one exception. These plans allow for some services from out-of-network providers of facilities. The out-of-network coverage will vary depending on your plan. Review your plan materials to see what benefits you can use from non-network providers.

Preferred Provider Organization (PPO)

PPO plans cover beneficiaries both in and out of the network. These plans offer more freedom to use the providers you want but typically have higher costs. These costs could be in the form of copays, premiums, or coinsurance. A referral is not usually required for specialists.

Private-Fee-For-Service (PFFS)

PFFS plans are usually found in rural areas. These plans allow beneficiaries to use any provider that accepts Medicare. However, it’s essential to understand that the doctor must agree to the plan’s terms before each and every visit. A visit can be covered today and not tomorrow. PFFS plans are the only Medicare Advantage option that allows you to select a Part D prescription drug plan in addition to the Medicare Advantage plan.

Special Needs Plan (SNP)

SNP plans are plan options specifically designed for Medicare beneficiaries with low income, specific chronic health conditions, or living in an institutionalized setting. These plans have particular benefits that assist members with these special needs.

Medicare Medical Savings Account (MSA)

These plans are hybrid-style plans that work similarly to a health savings account. These plans don’t include drug coverage, meaning you’ll have to select Part D prescription drug coverage. These plans allow for year-long enrollment as long as the plan accepts new members. There are not many areas that provide access to MSA plans.

How to find the best Medicare Advantage plan

In the world of Medicare, there is no such thing as the best. The reason for this is the fact that everyone’s healthcare needs and preferences are different. You’ll want to keep a few things in mind to ensure you choose the best plan for your situation. It’s easy to get distracted with all the plan extras, but most importantly, ask yourself these questions:

1. Do I often travel for more than one week at a time? A plan that allows out-of-network coverage is recommended if you travel for extended periods.
2. Will I be able to keep my current healthcare providers if I enroll in a new plan? In most areas, HMO plans will have the richest benefits, but you may have to give up a doctor here and there as they have restrictive networks. 

The different plans will cover different networks of doctors. The plan’s network determines which doctors you can see and how much you’ll pay. The healthcare providers that accept plans also change, so it’s essential to understand that the provider network could change mid-year.

3. Which plans provide better prescription drug coverage for my medications? If your medications aren’t covered under a plan, you could be setting yourself up for unknown and catastrophic drug costs.
4. Do the plan’s benefits meet your budget? Remember that you must still pay your Medicare Part B premium in addition to your Medicare Advantage deductible, copays, or coinsurance. You will also want to consider the maximum out-of-pocket limit for the plan when considering the price to value. Remember, these healthcare costs will vary depending on your chosen health plan and may change annually.

When you use a Medicare Advantage Plan, you can expect to pay at the time of service for most healthcare services. For most services, you’ll pay a fixed copay. However, some items may require coinsurance. The most common healthcare items that require coinsurance with Medicare Advantage are drugs administered in a physician’s office, durable medical equipment, chemotherapy, and dialysis.

5. Does the plan’s benefits meet your needs? Medicare Advantage Plans can include benefits not covered under Original Medicare. Some common additional benefits are listed below:

• Gym memberships
• Dental coverage
• Vision coverage
• Hearing coverage
• Healthy food cards
• Over-the-counter allowances 

It’s wise to consult your state SHIP, a local nonprofit, or Medicare itself to ensure that you get the benefits that you want and need.

6. Does the plan cover your prescriptions? Every Medicare Advantage plan has a drug formulary or specific list of covered prescription medications. These will typically not change mid-year, but reviewing the plan yearly is wise to ensure your prescriptions are appropriately covered.
7. How well is the plan rated? Medicare Advantage Plans are evaluated with a star rating scale. The rating varies from one to five stars. The star ratings help determine the quality and how well the plan you’re enrolling in is performing. There are dozens of factors that make up this scale, including quality measures related to health outcomes, hospital readmission rates, etc.

How to lower costs of your Medicare Advantage Plan

Several programs and public benefits can help with the costs of your Medicare Advantage Plans. Different programs can assist with various aspects and costs. 

If you qualify for the federal Extra Help program, you can get assistance with the drug portion part of your Medicare Advantage premium, which may lower or eliminate drug deductibles and copays for covered prescription medications. 

Medicare Savings Programs can help cover your out-of-pocket costs with Medicare. Learn more about the four types of Medicare Savings Programs here. 

You could also look into a prescription discount card. SingleCare’s free drug coupons may get you significant discounts on medications not covered by your plan or medications that are still expensive with Medicare. Note: These discounts would be used instead of your Medicare plan.

Medicare Advantage enrollment periods

Ready to enroll? You can only enroll or change a Medicare Advantage plan during specific times of the year. It’s important to know when you can make changes to your coverage if something on your plan is no longer working for you and you want to switch.

When you are first eligible for Medicare, you have an Initial Enrollment Period. The IEP for people who qualify for Medicare due to their age allows you a seven-month window to enroll in coverage starting three months before your 65th birthday. You can also qualify for Medicare prior to turning 65 if you have been collecting Social Security Disability Insurance for at least 24 months if you’ve been diagnosed with End-Stage Renal Disease and are on dialysis, or if you’ve been diagnosed with ALS.

The most well-known enrollment period is the Fall Open Enrollment Period, which runs from Oct. 15 to Dec. 7. During this time, you can make any changes to your Medicare insurance plans. If you elect a new plan, it will start on Jan. 1 of the following year.

The Medicare Advantage Open Enrollment Period runs from Jan. 1 to Mar. 31. You can make one change during this enrollment period if you currently have a Medicare Advantage plan. During this period, you can switch to a different Medicare Advantage plan, or you can drop your Part C coverage and enroll back into Original Medicare with or without a Part D plan. The new plan elected will begin on the 1st of the following month.

Special Enrollment Periods are tied to specific life events. In these cases, you might be able to change your Medicare Advantage plan outside of the usual enrollment periods. The most common example of a SEP is moving out of your plan’s coverage area. When this occurs, you’re allowed to enroll in a new plan in your new area.