Choosing a Medicare Advantage Plan

If you are like many Medicare beneficiaries, you may have access to Medicare Advantage plans in your area.

Choosing the right Medicare Advantage plan can have a significant impact on both your health care coverage and your financial situation. You should keep three things in mind when comparing Medicare Advantage plans: costs, benefits, and plan types.

How to Compare the Costs of Medicare Advantage Plans.

Premiums, coinsurance/copayments, and deductibles are the three types of costs associated with Medicare Advantage plans.

• Premiums: This is the amount you pay each month for insurance coverage. Premium amounts can range from $0 to more than $100 per month. The average Medicare Advantage premium in 2021 is expected to be $21 per month, according to the Centers for Medicare and Medicaid Services (CMS). You must still pay your Medicare Part B premium regardless of how much you pay for Medicare Advantage. When comparing Medicare Advantage plans, the first cost to consider is the premium. However, keep in mind that the plan with the lowest premium is not always the cheapest.

• Copayments/coinsurance: This is an amount you pay when you receive a service, such as $10 for a visit to a primary care physician or $100 for a brand-name drug prescription. Copayments and coinsurance may differ from one plan to the next. When comparing Medicare Advantage plans, consider the copayments for the services you use the most. For example, if you have arthritis and see a rheumatologist on a regular basis, compare how much different insurance plans charge to see a specialist.

• Deductible: the amount you pay before your plan starts paying. Medical care and prescription drugs typically have separate deductibles. Some Medicare Advantage plans have deductibles as low as $0, which means the plan will help you pay for covered services beginning with the first dollar spent.

Your out-of-pocket maximum is another important Medicare Advantage feature to compare. Every Medicare Advantage plan has an out-of-pocket maximum, which is an annual cap on how much you pay for covered services. The out-of-pocket maximum for Medicare Advantage may differ. Some plans, for example, may set the maximum at $6,700, while others may set it at $3,400. If you anticipate having to pay for expensive treatments or services, you may want to choose a Medicare Advantage plan with a low out-of-pocket maximum. Learn more about how your Medicare Advantage premiums will not count against your out-of-pocket maximum. Compare all of these cost factors before deciding on the best Medicare Advantage plan for you.

How to Compare the Benefits of Medicare Advantage Plans

At a bare minimum, all Medicare Advantage plans cover what Original Medicare (Parts A and B) does. That is, if Original Medicare covers a wheelchair or a vaccine, it is also covered by all Medicare Advantage plans. Extra benefits offered by Medicare Advantage plans may vary. Additional benefits may include:

• Coverage for prescription medications taken at home.

• Hearing exams and hearing aids are covered on a regular basis.

• Coverage for routine vision exams, contacts, and glasses.

• Gym memberships and exercise classes provide fitness benefits.

• Exams, cleanings, x-rays, fillings, dentures, and other routine dental care.

If a service is listed as “Same as Original Medicare benefits,” you will not typically receive additional coverage. For example, if your plan covers hearing in the same way that Original Medicare does, you will have to pay for your hearing aids out of pocket.

How to Contrast Medicare Advantage Plan Varieties

HMOs, PPOs, PFFSs, and SNPs are examples of common Medicare Advantage plan types. The plan type specifies the rules for having a primary care physician and seeing in-network providers. A network consists of medical professionals who have agreed to collaborate with your plan.

• Health Maintenance Organization (HMO)

An HMO is a type of Medicare Advantage plan in which you must choose a primary care physician. In most cases, a referral is required to see a specialist. Except in certain circumstances, services received outside of the plan's network of Medicare providers are typically not covered.

• Preferred Provider Organization (PPO)

You can generally go to any doctor or hospital with a PPO plan, but you will pay less if you use doctors and hospitals in the plan's network. In most cases, you do not need a referral to see a specialist.

• Private Fee-For-Service (PFFS)

A PFFS plan does not require you to select a primary care physician, and referrals are generally not required for treatment by specialists. However, your PFFS plan will not be accepted by all Medicare providers.

• Special Needs Plans (SNPs)

SNPs tailor benefits and coverage to the specific needs of plan participants. It's possible that you won't be able to find an SNP in your area that addresses your specific condition. For example, if the only SNP available in your area is a diabetes plan and you do not have diabetes, you may be unable to enrol.

Other methods for comparing Medicare Advantage plans

When shopping for Medicare Advantage plans, you may notice that each plan has a star rating ranging from one to five stars. The star rating reflects how satisfied beneficiaries are with the plan. that have an impact on the rating are:

• Surveys of member satisfaction

• Surveys of providers

• Information about the plan

Do you want to compare Medicare Advantage plans in your neighbourhood? Simply enter your zip code at the top of this page to see what's available to you.