How to Choose the Best Medicare Advantage Plan for You

When beginning your search for a Medicare Advantage (Part C) plan, it’s important to know the differences between each type of plan. You’ll probably see some or all of the following types of plans when reviewing your options:

• Health Maintenance Organization (HMO) plans. These plans are primarily focused around in-network healthcare services.
• Preferred Provider Organization (PPO) plans. These plans charge different rates depending on whether the services are in network or out of network. (A “network” is a group of providers who contract to provide services for the specific insurance company and plan.) These may provide more options to receive out-of-network care.
• Private Fee-for-Service (PFFS) plans. These plans let you receive care from any Medicare approved provider who will accept the approved fee from your plan.
• Special Needs Plans (SNPs). These plans offer additional help for medical costs associated with specific chronic health conditions.
• Medicare Savings Account (MSA) plans. These plans combine a health plan that has a high deductible with a medical savings account.

Each plan offers options to accommodate your healthcare needs. If you have chronic health conditions, SNPs are designed to help alleviate some long-term costs. On the other hand, a PFFS or MSA plan might be beneficial if you travel and need to see out-of-network providers.

With all the changes being made to the Medicare plans on the market, it can be hard to narrow down the best plan for you. Here are a few things to look for in a Medicare Advantage plan:

• costs that fit your budget and needs
• a list of in-network providers that includes any doctor(s) that you would like to keep
• coverage for services and medications that you know you’ll need
• Centers for Medicare & Medicaid Services (CMS) star rating

Read on to learn what else you might consider when shopping for Medicare Advantage plans in your area.

Research CMS star ratings

The CMS has implemented a 5-star rating system to measure the quality of health and drug services provided by Medicare Advantage and Medicare Part D (prescription drug) plans. Every year, the CMS releases these star ratings and additional data to the public.

The CMS ratings can be a great place to start when shopping around for the best Medicare Advantage plan in your state. Consider researching these plans for more information on what coverage is included and how much it costs.

To see all available Medicare Part C and D 2022 star ratings, visit CMS.gov and download the 2022 Part C and D Medicare Star Ratings Data.

Consider your coverage priorities

All Medicare Advantage plans cover what original Medicare covers — this includes hospital coverage (Part A) and medical coverage (Part B).

When you choose a Medicare Advantage plan, you first want to consider what type of coverage you need in addition to the coverage above.

Most Medicare Advantage plans offer one, if not all, of these additional types of coverage:

• prescription drug coverage
• dental coverage, including yearly exams and procedures
• vision coverage, including yearly exams and vision devices
• hearing coverage, including exams and hearing devices
• fitness memberships
• medical transportation
• additional healthcare perks

Finding the best Medicare Advantage plan means making a checklist of the services you want to receive coverage for. You can then take your coverage checklist to Medicare’s find a plan tool and compare plans that cover what you need.

If you find a plan that looks good for you, don’t be afraid to call the company to ask if they offer any additional coverage or perks.

Determine your budget and potential healthcare costs

One of the most important things to consider when choosing the best Medicare Advantage plan is how much it will cost you. The find a plan tool lists the following cost information with the plans:

• monthly premium
• Part B premium
• in-network yearly deductible
• drug deductible
• in- and out-of-network out-of-pocket max
• copays and coinsurance

These costs can range from $0 to $1,500 and above, depending on your home state, the plan type, and the plan benefits.

To get a starting estimate of your yearly costs, consider the premium, deductible, and out-of-pocket max. Any deductible listed is the amount that you’ll owe out-of-pocket before your insurance begins to pay out. Any out-of-pocket max listed is the maximum amount that you will pay for the services throughout the year.

When estimating your plan costs, consider these costs plus how often you will need to refill prescription drugs or make office visits.

If you require specialist or out-of-network visits, include those potential costs into your estimate as well. Don’t forget to consider that your amount may be lower if you receive any financial assistance from the state.

Review other benefits you may already have

If you already receive other types of healthcare benefits, this may factor into what kind of Medicare Advantage plan you’ll need.

For example, if you already receive original Medicare and have opted to add Part D or Medigap, many of your needs may already be covered.

However, you can always do a coverage comparison to determine if a Medicare Advantage plan would work better or be more cost-efficient for you.

The Medicare enrollment process can begin as early as 3 months before you or your loved one turns 65 years old. This is the best time to apply, as it will ensure that you receive coverage by your 65^th birthday.

You can wait to apply for Medicare until the month of your 65^th birthday or the 3 months following your birthday. However, coverage can be delayed if you wait, so try to apply early.

If you decide not to enroll in a Medicare Advantage plan when you first turn age 65, you have another chance during Medicare’s annual open enrollment period.

From October 15 through December 7 each year, you can switch from original Medicare to Medicare Advantage. You can also switch from one Medicare Advantage plan to another or add, remove, or change a Part D plan.

There are many factors that can influence which Medicare Advantage plan you choose. Consider the CMS star rating, your priorities and healthcare needs, how much you can afford, and what type of insurance you currently have.

It’s important to enroll in Medicare before you turn age 65 to ensure that you don’t go without medical coverage. Don’t forget that you have the power to shop around for the best Medicare Advantage plan that fits all your needs.