With dozens of Medicare Advantage Plans available, selecting the right one for your unique needs can feel overwhelming. However, by researching options, comparing benefits and costs, and understanding your healthcare priorities, you can confidently determine the optimal Medicare Advantage Plan for you.
Medicare Advantage vs Original Medicare
Before evaluating plans, it helps to understand Medicare Advantage and how it differs from Original Medicare.
Medicare Advantage (also called Medicare Part C) offers an alternative way to receive your Medicare benefits. Private insurance companies approved by Medicare provide coverage through Medicare Advantage Plans rather than the federal government covering you directly as with Original Medicare.
Original Medicare consists of Part A (hospital coverage) and Part B (outpatient services). Most people don’t pay a premium for Part A but do pay for Part B. With Original Medicare, you can visit nearly any doctor or facility in the U.S. that accepts Medicare without referrals. You can add separate prescription drug coverage through a Medicare Part D drug plan.
- Cost Sharing: With Original Medicare, you pay 20% coinsurance plus the Part B deductible. Medicare Advantage Plans have annual out-of-pocket spending limits.
- Provider Choice: Original Medicare offers near universal provider acceptance, while Medicare Advantage Plans have network restrictions.
- Benefits: Most Medicare Advantage Plans include prescription drug coverage. Some offer additional benefits like vision and dental.
- Travel: Original Medicare covers healthcare throughout the U.S. Most Medicare Advantage Plans only cover non-urgent care within the plan’s service area.
Now let’s explore how to find and choose the optimal Medicare Advantage Plan for your situation.
How To Choose the Best Medicare Advantage Plan in 2024
Research Highly-Rated Medicare Advantage Plans
Your first step involves investigating the range of Medicare Advantage Plans available where you live. Keep these factors in mind while researching:
- Types of plans: Medicare Advantage Plans come in several forms including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Compare plans to choose your preferred model.
- Star ratings: Medicare evaluates plans on a 5 star quality rating system. Favor plans with 4 stars or higher.
- Costs: Check monthly premiums, deductibles, copays or coinsurance rates, and maximum out-of-pocket limits. Make sure costs align with your budget.
- Benefits: Most Medicare Advantage Plans include Part D Medicare drug plan. Many also offer extra benefits like dental, vision and hearing services. Seek robust benefits.
- Wellness programs: Some plans provide members gym memberships, over-the-counter allowances or personalized health coaching. These perks promote healthy living.
Use Medicare’s Compare Medicare Advantage Plans tool or independent review sites like NerdWallet to contrast plans available in your location. Focus on highly-rated plans matching your priorities.
Confirm Your Doctors Participate
Before locking in a Medicare Advantage Plan, verify your preferred medical providers participate in the plan’s network. Most Medicare Advantage Plans require you to see in-network doctors and facilities except in emergencies. Using out-of-network providers results in higher out-of-pocket costs or no coverage at all.
To avoid surprises, check provider directories through the insurance company offering the Medicare Advantage Plan you’re considering. Medicare can also help you compare Medicare Advantage Plans and provider networks in your area.
Evaluate Prescription Drug Coverage
Next compare the Part D Plan offered by each Medicare Advantage Plan under consideration. Key factors include:
- Covered medications: Make sure the plan by the health care provider covers all prescription drugs you currently take.
- Pharmacy networks: Confirm your preferred pharmacy accepts the plan to avoid higher medication costs.
- Formulary tiers: Pay attention to which tier your drugs fall under as this impacts your cost-sharing amount.
- Restrictions: Some plans implement quantity limits, preauthorization requirements or step therapy protocols.
Thoroughly understanding how Medicare Advantage Plans differ in Part D benefits ensures your ongoing medication needs are covered affordably.
Assess Additional Benefits
While all Medicare Advantage Plans must provide the same base benefits as Original Medicare, many offer additional benefits not included with Original Medicare. Extra benefits to look for can include:
- Vision care: eye exams, prescription eyewear reimbursement
- Hearing coverage: hearing exams, hearing aids
- Dental care: cleanings, x-rays, certain procedures
- Fitness membership: gym network with free basic membership
- Over-the-counter allowance: dollars to spend on approved OTC items
- Transportation: rides to doctors appointments
- Meal delivery: meals provided after hospitalization
- Telehealth: virtual doctor and specialist visits
- Caregiver support: for members caring for loved ones
- Personal home helper: assist with household chores
Compare Medicare Advantage Plans to find one that provides maximum supplemental benefits meeting your health and lifestyle priorities.
Verify Travel Coverage
One key area where most Medicare Advantage Plans differ from Original Medicare involves healthcare coverage outside your plan’s service region. While Original Medicare covers emergencies and urgent care nationally, Medicare Advantage Plans generally only cover non-emergency services within the plan’s network area expect in emergencies.
If you travel frequently, Medicare Supplement Insurance (Medigap) paired with Original Medicare may better suit your lifestyle. Some Medicare Advantage Plans do offer emergency travel coverage as an extra benefit. Carefully investigate options to ensure your plan provides healthcare access while traveling if needed.
Choose Your Plan Confidently
Selecting a Medicare Advantage Plan means weighing various factors from costs to covered services and providers. While evaluating options can initially seem confusing, taking an organized approach simplifies the process. Define your priorities around plan costs, healthcare needs and lifestyle considerations. Then thoroughly compare Medicare Advantage Plans available in your area to find your best fit.
Most people can enroll in Medicare Advantage Plans when first eligible for Medicare, during Medicare’s Annual Election Period (October 15 to December 7) or during Special Election Periods if qualified. Carefully review when you can sign up to avoid penalties or delays in coverage.
By understanding key differences among plans, assessing your individual situation and carefully comparing options using trustworthy tools, you can confidently enroll in a Medicare Advantage Plan well-matched to your needs and budget.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at American Entitlements a Call at (469) 814-0289. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
What are the different types of Medicare?
Medicare is divided into four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage Plans), and Part D (prescription drug coverage).
How do I find the best Medicare Advantage Plan for 2024?
You can use the Medicare Plan Finder tool on the official Medicare website to compare plans, costs, and coverage options to find the best Medicare Advantage Plan for 2024 that suits your needs.
What are the types of Medicare Advantage Plans available?
Medicare Advantage Plans include HMO (Health Maintenance Organization) plans, PPO (Preferred Provider Organization) plans, Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medical Savings Account (MSA) plans.
How do I choose a Medicare Advantage Plan?
When choosing a Medicare Advantage Plan, consider factors such as the cost, coverage, network of healthcare providers, prescription drug coverage, and additional benefits like dental or vision care.
Do Medicare Advantage Plans have deductibles?
Yes, some Medicare Advantage Plans may have deductibles, but not all plans include deductibles. It’s important to carefully review the details of each plan before enrolling.
Can I enroll in a Medicare Advantage Plan with Blue Cross Blue Shield?
Yes, many Blue Cross Blue Shield entities offer Medicare Advantage Plans. You can check with your local Blue Cross Blue Shield provider to see if they offer Medicare Advantage Plans and compare them with other available options.
Are there low-cost Medicare Advantage Plans available?
Yes, there are low-cost Medicare Advantage Plans offered by various insurance providers. You can use the Medicare Plan Finder tool to search for and compare affordable plan options.
What are the best Medicare Advantage providers?
Some of the top Medicare Advantage providers include UnitedHealthcare, Humana, Aetna, Cigna, and Blue Cross Blue Shield, but the best provider for you will depend on your specific needs and location.
What do Medicare Advantage Plans cover?
Medicare Advantage Plans cover all the services that Original Medicare covers, and most plans offer additional benefits such as vision, dental, hearing, and prescription drug coverage.
How can I sign up for Medicare and Medicare Advantage Plans?
You can sign up for Medicare during your Initial Enrollment Period (IEP) or the Annual Enrollment Period (AEP). To enroll in a Medicare Advantage Plan, you will need to go through an approved private insurance company that offers these plans.