Are you ready to compare your Medicare Advantage plan options?
If so, there are a few things you should know before you get started.
This article will review how Medicare Advantage plans differ and explore a few simple ways to compare plans.
There are over 3,834 Medicare Advantage plans available nationwide in 2022.1
Depending on where you live, there may be $0 premium Medicare Advantage (Part C) plans available in your area.
In fact, 96 percent of Medicare beneficiaries have access to a Medicare Advantage Prescription Drug plan (MA-PD) with no monthly premium.1
Most Medicare Advantage plans include prescription drug coverage, and some plans may even cover things like routine dental, vision and hearing care.
So how do you find the right plan for your needs with all those options?
You can narrow down your options by comparing plan benefits, types, costs and star ratings.2
And if you don’t want to wait, you can compare your plan options online now.
Finding the right Medicare Advantage plan to fit your needs will depend on the types of health coverage you want, your budget and the availability of plans where you live.
The cost of Medicare insurance plans can be determined by a variety of factors:
All other things being equal, Part C plans that offer more benefits may have higher premiums than plans with fewer benefits.
Common benefits offered by some Medicare Advantage plans include coverage for dental, vision, hearing, prescription drugs and fitness programs such as SilverSneakers.
Medicare Advantage plan quotes may differ according to location.
For example, in 2022, the average Medicare Advantage plan premium in New York is $71.30 per month, while the average premium in South Carolina is just $38.38 per month.3
Learn more about Medicare Advantage in your state.
Medicare Advantage plans are all sold by private insurance companies.
These companies may set their own premiums, deductibles and other costs, all of which may affect the plan quotes available to you.
There are several types of Medicare Advantage plans.
The most common plan types are Health Maintenance Organization plans (HMO), Preferred Provider Organization plans (PPO), Private Fee-for-Service plans (PFFS) and Special Needs Plans (SNP).
Each plan type has different network rules which may impact which medical providers you can use, how you receive your medical care and how much it will cost.
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As mentioned above, there are several different types of Medicare Advantage plans you may be able to consider.
The plan options available to you may vary and may include more or less than the plans listed below.
A Medicare Advantage health maintenance organization (HMO) plan is a type of health plan that typically utilizes a local network of doctors, health care providers and hospitals.
With an HMO plan, you are typically limited to a local network of providers for care that will be covered by your plan. You are also usually required to choose a primary care physician (PCP) from your local plan network.
Your plan may require you to get a referral from your PCP before visiting a specialist for additional care.
Be sure to check with your plan carrier to find out more about the rules and network restrictions of your plan.
A Medicare Advantage preferred provider organization (PPO) plan is a type of health plan that may offer you the ability to receive approved health care outside of your plan network.
Your plan costs will typically be lower, however, if you see providers within your PPO plan network.
A PPO plan may require you to choose a primary care physician, but it is not typically a requirement. PPO plans typically don’t require you to get a referral in order to see a specialist.
A Medicare Advantage private fee-for-service (PFFS) plan is a type of health insurance plan that allows you to visit any Medicare-approved doctor or facility that accepts your plan’s payment terms and conditions.
Some PFFS plans may include a provider network. If your PFFS plan includes a network, you may pay higher costs when you seek care from an out-of-network providers.
With most PFFS plans, you don’t have to get a referral to see a specialist.
A Medicare Advantage Special Needs Plan (SNP) is a type of specialized Medicare Advantage plan that is designed to provide customized services and coverage to people with specific health conditions or financial needs.
All Medicare Advantage SNPs include prescription drug coverage.
There are three main types of Medicare Advantage Special Needs Plans:
The table below illustrates some of the key differences between each type of Medicare Advantage plan.
|Utilizes a network of health care providers||Yes||Yes||No||Yes|
|Utilizes a primary care physician (PCP)||Yes||No||No||Yes|
|Offers non-emergency coverage outside of the plan's network||Yes||Yes, but may cost more||Yes||No|
|Requires a referral to see a specialist||Typically yes||No||No||Yes|
|May include drug coverage||Yes||Yes||Yes||Yes, all SNPs include drug coverage|
Medicare Advantage plans have several different costs you should consider including premiums, deductibles, copayments and coinsurance.
Your costs will vary depending on which plan you choose and which medical services you receive.
Keep in mind that you may have $0 premium plan options available in your area. If you enroll in one of these plans, you still have to pay your Medicare Part B premium.
Each fall, the Centers for Medicare & Medicaid Services releases a star ratings report for all Medicare Advantage and Medicare Part D prescription drug plans.
These Medicare Star Ratings can change each year.2
Each plan is rated from one to five stars on a variety of criteria, with one star being “poor” and five stars being “excellent”. Plans that are rated with 4 stars or higher are considered "top-rated" Medicare Advantage plans.
Medicare releases its star ratings report each fall, typically just prior to the Annual Enrollment Period (AEP, also called the Annual Election Period).
Medicare AEP lasts from October 15 to December 7 every year.
You may also do some research on the carriers who provide Medicare Advantage plans in your area.
Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide valuable insight about the financial well-being of an insurance company.
And sites like Consumer Reports and the Better Business Bureau can shed some light on overall consumer satisfaction.
You can also browse customer reviews and testimonials online.
Comparing plans online with Medicare.gov or MedicareAdvantage.com or over the phone with a licensed insurance agent can help you find an affordable plan quickly.
One way to compare plans online is using the Medicare.gov “Medicare Plan Finder” tool. Medicare.gov is the official U.S. Government site for the Medicare program.
The site offers two search options: a general search and a personalized search.
If you use the general search, you can find Medicare plans in your area, but the cost estimates may not be as accurate as the personalized search.
In order to view your plans on the general search, you will need to answer some questions such as your ZIP code, how you get your Medicare coverage and if you get help paying your Medicare prescription drug costs.
If you use the personalized search, you will be able to view Medicare plans in your area with more accurate cost estimates than the general search.
In order to view your plans on the personalized search, you will need to answer specific Medicare questions such as your Medicare number, Part A effective date, date of birth and other questions.
Both search options show several types of Medicare plans in your area with detailed plan information such as estimated annual costs, premiums, Star Ratings and plan benefits.
If you want to compare plans online and have one-on-one support from a licensed insurance agent, then you can use MedicareAdvantage.com.
MedicareAdvantage.com offers an online plan comparison tool where you can review Medicare Advantage plans side by side.
You will be able to view plan details, benefits, costs, Star Ratings and other information.
If a plan fits your needs, you can start the application process right away by calling a licensed insurance agent at TTY Users: 711 or by entering your information online and having a licensed insurance agent call you directly.
Even if you aren’t ready to apply, our USA-based, licensed insurance agents are available to answer your questions and discuss your plan options.
Reviewing plans online with MedicareAdvantage.com gives you the freedom to compare several plan options at your own pace and speak with a licensed insurance agent when you have questions.
If you’re looking for the most efficient way to compare plans, then you should consider comparing plans over the phone.
When you compare plans with a licensed insurance agent directly over the phone, you will have access to all the plan information mentioned above such as plan details, benefits, costs and other information.
What makes comparing plans over the phone different is that if you have any questions during the plan comparison process, such as how a certain benefit may help you or how much the plan’s deductible is, a licensed insurance agent can answer your questions right away.
All of our licensed insurance agents are based in the USA and can help you understand your plan options. Our help is provided at no cost to you. This means you are under no obligation to purchase a policy from us.
But, if you do find a plan that works for your coverage needs, you can start your enrollment process in just a few minutes.
Get started immediately by calling TTY Users: 711.
89 percent of 2022 Medicare Advantage plans cover prescription drugs.1
You can speak to a licensed insurance agent to find out if there are any MAPD plans available where you live.
If there are, an agent can also help you find out if your Medicare Advantage plan covers your prescription drugs.
If you are about to become eligible for Medicare or have recently become eligible, you may be able to enroll in a Medicare Advantage plan during your Medicare Initial Enrollment Period (IEP).
A licensed insurance agent can help you explore your enrollment options, such as when is the right time for you to enroll in a Medicare Advantage plan.
Your Medicare Part C plan premium is the cost you must pay – typically monthly – to belong to the plan. Premiums can vary from one plan and one geographical location to another.
It’s important to note that many areas of the U.S. may feature $0 premium plans. In fact, more than nine out of ten Medicare Advantage plan beneficiaries (98 percent) in 2022 have access to a $0 premium MA-PD plan.1
Some variables that can affect the cost of a Medicare Part C premium include:
While most people do not pay a premium for Medicare Part A, beneficiaries typically pay the standard Part B premium, which is $170.10 per month in 2022.
People who report higher incomes may more for their Part B premiums, due to what is called the Medicare Income-Related Monthly Adjustment Amount (IRMAA).
A deductible is the amount you must pay out of your own pocket toward the costs of covered services and items before your plan coverage kicks in.
Some Medicare Advantage plans may include $0 deductibles.
Medicare Advantage plans that include prescription drug coverage (MA-PD plans) may include an annual drug deductible.
In 2022, the weighted average drug deductible for MA-PD plans is $293 per year.3
Medicare Part B requires an annual deductible of $233 for the year in 2022.
The 2022 Medicare Part A deductible is $1,556 per benefit period.
Cost-sharing measures are the share of medical bills that you must pay after your deductible has been met.
Cost-sharing can typically come in two forms:
Cost-sharing such as coinsurance and copays with Medicare Part C plans may vary by plan.
Part B of Medicare typically requires a 20 percent coinsurance payment for covered services and items (after you meet your Part B deductible).
Part A coinsurance can reach as high as $778 per day in 2022 for extended inpatient hospital stays.
A Medicare Advantage plan out-of-pocket spending limit represents an annual cap on your out-of-pocket spending for covered Part A and Part B health care costs.
Once you have reached this amount, your Part C plan will pay for 100 percent of the cost of all covered services and items for the remainder of the year.
By law, all Part C plans must contain an out-of-pocket limit of no more than $7,550 in 2022.
The out-of-pocket limit can help protect you from Medicare out-of-pocket costs that can add up quickly as a result from a serious injury or illness that requires lengthy inpatient hospital stays.
Original Medicare does not feature an out-of-pocket limit, which can be one factor many beneficiaries may consider in joining a Medicare Advantage plan.
If you have questions about Medicare Part C costs or would like to compare Part C plans available in your area, call to speak with a licensed insurance agent today.
1 Freed M. et al. (Nov. 2, 2021). Medicare Advantage 2022 Spotlight: First Look. Kaiser Family Foundation. www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look.
2 Every year, Medicare evaluates plans on a 5-star rating system.
3 MedicareAdvantage.com's analysis of Centers for Medicare & Medicaid Services (CMS) 2022 MA Landscape Source Files. (Oct. 26, 2021). https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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