Comparing Medicare Advantage Plans

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 11/21/2018

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If you’re like many Medicare beneficiaries, you could have options for Medicare Advantage plans available in your area.

Choosing the right Medicare Advantage plan could have a significant impact on your health care coverage and your finances. You will want to take note the three main things to compare about Medicare Advantage plans are costs, benefits, and plan types.

How to compare Medicare Advantage plan costs

Medicare Advantage plans have three types of costs: premiums, coinsurance/copayment, and deductibles.

  • Premiums: this is the amount you pay monthly for coverage. Typical premium amounts can range from $0 to over $100 a month. According to the Centers for Medicare and Medicaid Services (CMS), the average Medicare Advantage premium in 2018 was $30/month. Regardless of how much or little you pay for Medicare Advantage premium, you still must pay your Medicare Part B premium. The first cost you may consider when you compare Medicare Advantage plans is the premium. However, keep in mind that plans with the lowest premium may not necessarily be the cheapest plan.
  • Copayments/coinsurance: this is an amount you pay when you receive a service, for example, $10 for a visit to a primary care physician or $100 to fill a prescription for a brand-name drug. Copayments and coinsurance may vary from plan to plan. As you compare Medicare Advantage plans, look at the copayments for the services you receive the most. For example if you have arthritis and regularly see a rheumatologist, look at what different plans charge to see a specialist.
  • Deductible: this is the amount you pay before your plan begins to pay. You usually have separate deductibles for medical care and prescription drugs. Some Medicare Advantage plans have $0 deductibles, meaning the plan will help you pay starting with the first dollar you

Another important Medicare Advantage feature to compare is your out-of-pocket maximum. All Medicare Advantage plans have an out of pocket maximum, which is an annual limit on what you pay for covered services. The Medicare Advantage out-of-pocket maximum can vary. For example, some plans might set the maximum at $6,700, and others may set it at $3,400. If you expect expensive treatments or services, you may want to opt for a Medicare Advantage plan with a low out of pocket maximum. Read more on how your Medicare Advantage premiums won’t count towards your out of pocket maximum.

Compare all these costs factors before deciding which Medicare Advantage plan is the cheapest for you.

How to compare Medicare Advantage plan benefits

All Medicare Advantage plans cover at a minimum what Original Medicare (Part A and Part B) cover. That means if a wheelchair or vaccine is covered by Original Medicare, it is also covered by all Medicare Advantage plans. Medicare Advantage plans may differ on extra benefits. Extra benefits may include:

  • Prescription drug coverage for medications you take at home
  • Routine hearing coverage for exams and hearing aids
  • Routine vision coverage for eye exams, contacts, and glasses
  • Fitness benefits for gym memberships and exercise classes
  • Routine dental care for exams, cleanings, x-rays, fillings, dentures and more

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

How to compare Medicare Advantage plan types

Common Medicare Advantage plan types include HMOs, PPOs, PFFS, and SNPs. The plan type indicates the rules about having a primary care doctor and seeing providers in network. A network is made up of medical professionals who have agreed to work with your plan.

  • Health Maintenance Organization (HMO)

An HMO is a type of Medicare Advantage plan that generally requires you to select a primary care doctor. In most cases, you need to get a referral to see a specialist. Except under certain circumstances, you’re typically not covered for services you receive outside of the plan’s network of Medicare providers.

  • Preferred Provider Organization (PPO)

With a PPO plan, you can generally go to any doctor or hospital, but will pay less if you use doctors and hospitals that belong to the plan’s network. You generally don’t need a referral to see a specialist.

  • Private Fee-For-Service (PFFS)

With a PFFS plan, you will not need to choose a primary care doctor, and referrals are generally not required for treatment by specialists. However, not all Medicare providers will accept your PFFS plan.

  • Special Needs Plans (SNPs)

Special Needs Plans (SNPs) tailor benefits and coverage to meet the specific needs of the people enrolled in the plan. An SNP is generally the only way that people with end-stage renal disease can enroll in a Medicare Advantage plan. You might not be able to find an SNP in your area that addresses your specific condition. For example, the only SNP available in your area may be a diabetes plan and you don’t have diabetes.

Other ways to compare Medicare Advantage plans

As you are shopping for Medicare Advantage plans, you may notice that all plans have a star rating, which goes up to five stars. The star rating indicates how happy beneficiaries are with the plan. Factors that influence the rating are:

  • Member experience with the health plan
  • Member complaints about the plan’s performance
  • How much the plan’s performance has improved over time
  • The health plan customer service
  • How well the plan handles member appeals

Do you want to compare Medicare Advantage plans in your area? Just enter your zip code on this page to see what is available to you.

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