Choosing the best Medicare Advantage plans for seniors can make a significant difference in healthcare costs, provider access, prescription coverage, and additional benefits. Medicare Advantage, also known as Medicare Part C, is offered by Medicare-approved private insurance companies and provides an alternative way to receive Medicare Part A and Part B benefits. Most Medicare Advantage plans also include prescription drug coverage through Part D.
Because plans differ by location, healthcare needs, providers, medications, premiums, and benefits, seniors should compare several options before enrolling.
What Is Medicare Advantage?
Medicare Advantage is an alternative to Original Medicare. To enroll, you generally need both Medicare Part A and Part B. Instead of receiving Medicare-covered healthcare directly through Original Medicare, you receive your Medicare benefits through a private plan that contracts with Medicare.
Many Medicare Advantage plans combine hospital, medical, and prescription drug coverage into one plan. Depending on the plan, seniors may also receive additional benefits such as dental, vision, hearing, or fitness-related services.
However, coverage and benefits can vary considerably between plans, making comparison especially important.
Types of Medicare Advantage Plans
Seniors can choose from several types of Medicare Advantage plans. The most common are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans.
HMO plans generally require members to use doctors and hospitals within the plan’s network, except for certain emergency or urgent situations. Some HMO plans also require referrals before seeing specialists.
PPO plans generally provide more flexibility when choosing healthcare providers. Members can typically use out-of-network providers, although they may pay more.
Special Needs Plans (SNPs) are designed for people who meet specific eligibility requirements, including certain chronic conditions or situations involving Medicaid. SNPs can provide benefits tailored to particular healthcare needs.
Other options include Private Fee-for-Service and Medical Savings Account plans.
How to Find the Best Medicare Advantage Plan
There is no single Medicare Advantage plan that is best for every senior. The right plan depends on your healthcare requirements and budget.
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Check Your Doctors and Hospitals
Before choosing a plan, confirm that your preferred primary care doctor, specialists, hospitals, and other healthcare providers participate in the plan’s network.
Network restrictions can be particularly important for seniors who regularly visit specialists or receive treatment at a particular hospital. Medicare notes that Medicare Advantage members may need to use in-network providers for non-emergency care, depending on their plan.
Review Prescription Drug Coverage
If you take prescription medications, check whether each medication is included in the plan’s drug coverage. You should also compare the pharmacy network, copayments, coinsurance, and other prescription-related costs.
A plan with a low monthly premium may not necessarily be the cheapest option overall if your medications have high out-of-pocket costs.
Compare Premiums and Out-of-Pocket Costs
Cost is another major factor when comparing Medicare Advantage plans. Some plans have $0 monthly premiums, while others charge an additional premium. You must generally continue paying your Medicare Part B premium even when enrolled in a Medicare Advantage plan.
Look beyond the monthly premium and examine deductibles, copayments, coinsurance, and the plan’s annual out-of-pocket maximum. The total cost of healthcare can be more important than the advertised premium.
Consider Extra Benefits
One reason seniors choose Medicare Advantage is the possibility of receiving benefits that Original Medicare generally does not cover.
Depending on the plan, additional benefits may include dental, vision, hearing, fitness, transportation, or other services. However, benefits differ by plan and may have specific eligibility requirements, limits, or restrictions.
Rather than choosing a plan because of one attractive benefit, consider whether the benefits are actually useful for your healthcare needs.
Check Medicare Star Ratings
Medicare’s Star Ratings can help seniors compare the quality and performance of Medicare Advantage and prescription drug plans. The ratings evaluate multiple aspects of plan performance and provide a standardized way to compare plans.
A higher rating can be useful when comparing otherwise similar plans, but seniors should also evaluate provider networks, costs, prescription coverage, and benefits.
Medicare Advantage vs. Original Medicare
Medicare Advantage can provide the convenience of combining Medicare benefits into one private plan and may include additional benefits. It also provides an annual limit on out-of-pocket costs for covered Medicare services.
Original Medicare, on the other hand, generally allows beneficiaries to visit any doctor or hospital that accepts Medicare anywhere in the United States. Seniors can also purchase Medigap coverage to help with certain out-of-pocket expenses.
The better option depends on your healthcare preferences, budget, providers, medications, and travel needs.
Final Thoughts
Finding the best Medicare Advantage plans for seniors requires comparing more than monthly premiums. Review provider networks, prescription coverage, out-of-pocket costs, Star Ratings, additional benefits, and plan rules before making a decision.
Because Medicare Advantage plans can differ significantly by location and may change from year to year, seniors should review their options carefully during the appropriate enrollment period. Medicare’s official Plan Compare tool allows beneficiaries to compare available health and drug plans based on their location and individual circumstances.
Taking time to compare plans can help seniors select Medicare coverage that better fits their healthcare needs and financial situation.
