How to Choose a Medicare Advantage Plan

More than one-third (36%) of Medicare beneficiaries are in a Medicare Advantage plan. A Medicare Advantage plan covers just about everything Original/Traditional Medicare covers and even offers a few extra benefits. While the federal government manages Original Medicare, Medicare Advantage is made available by private health insurers.

If you are looking into Medicare Advantage plans, you can save yourself some time by checking out some of the top-rated programs — Health has reviewed the best Medicare Advantage plans in 2020. Below, we will look at factors to consider when selecting a plan.

Find a List of Medicare Advantage Plans Available in Your State

Plans, coverage, and costs vary by state and county. Before taking any step, make sure you see all the plans in your area. Visit the Medicare Plan Finder website and go through the list of plans available.

Determine Which Coverage Features Are Most Important to You 

When searching for a Medical Advantage plan, it’s essential that you first identify your priorities. From here, consider what type of coverage you need, on top of what Original Medicare provides. Check whether the insurer offers out-of-network coverage, prescription drug coverage, and maximum limits on out-of-pocket costs. Also, look for dental, vision, and hearing coverage. Some plans also offer extra perks such as fitness memberships, wellness coaching, and support groups. Decide first what features are must-haves for you.

Research CMS Star Ratings 

Before enrolling in a plan, you’ll want to know the quality of health and drug services offered by the insurer. The Centers for Medicare & Medicaid Services (CMS) has a useful rating system and resources that can help you guide your decision. You will find rating categories ranging from members’ satisfaction, customer service availability, drug pricing, medication safety to availability of health screenings. Plans that get four or five stars receive extra money from the government to invest in your medical benefits.

Compare Costs and Benefits

Learn the cost information of the different Medicare Advantage plans before you enroll in any program. Some plans’ costs are as low as $0, and some can go up to $1,500 depending on where you live, the type of plan, and the benefits offered. To estimate what you will pay in a year, check out the following:

• Health Insurance Premiums – The amount you pay for your health insurance plan to be able to use their coverage. Depending on the insurance plan, the payment will be done monthly, bi-annually, or annually.
• Deductibles – Amount of money you pay towards every medical expense before your insurance plan starts to pay.
• Co-payments – The fixed-rate amount you have to pay after you’ve met your deductible. It applies to doctor’s appointments, prescription medication purchases, and other types of care.
• Out-of-pocket limit – The most you will pay each year for covered services. 

Learn the Different Plan Structures

There are five types of Medicare Advantage plan structures, and each one affects how you use your program: 

• Health Maintenance Organization (HMO) – You will only be covered if your doctor is in the insurer’s network.
• Preferred Provider Organizations (PPOs) – You can use any doctor you want, but you’ll pay less when you use a doctor who’s in the network.
• Private Fee-for-Service (PFFS) – You will be covered if your doctor accepts the approved fee from your plan.
• Special Needs Plans (SNP) – You will get additional help for expenses associated with specific chronic conditions.
• Medicare Medical Savings Account (MSA) – If your health plan has a high deductible, it’s combined with your medical savings account.

Start Finding the Best Plan for You

There are many factors to consider before choosing a Medicare Advantage plan. Determine your healthcare needs, check the CMS star rating, calculate how much you can afford, look for extra benefits, and decide which plan structure suits you best.