What Medicare Advantage Plan Is Right for You?

There were 2,317 Medicare Advantage plans available for purchase in 2018.1 With such a large number of plans from which to choose, how can you identify one that might fit your unique health care coverage needs?

Senior couple looking at a lake

The Best Medicare Advantage plans of 2018

The Centers for Medicare & Medicaid Services (CMS) uses a star rating system to rate the performance of Medicare Advantage plans each year.2 The system is used to measure Medicare Advantage and Medicare Part D stand-alone prescription drug plans, and it rates plans from one to five stars:

Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

The star rating system used for Medicare Advantage plans provides an overall review of each plan’s quality and performance based on five key metrics: 

  • Screening tests and vaccines
    This review criteria evaluates whether or not plan members had access to preventive services, including annual physical exams and screenings.
  •  
  • Management of chronic conditions
    This includes the coordination of care under a given Medicare Advantage plan and also evaluates how often members received treatment for long-term health conditions.
  •  
  • Member experience with the plan
    These criteria evaluate plan members’ overall satisfaction with the given plan.
  •  
  • Member complaints and changes in plan performance
    How frequently did plan members submit complaints about the plan, have problems receiving covered services or opt out of the plan? This rating criteria also reflects whether the plan’s performance improved from the previous year.
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  • Customer service
    The quality of call center service along with the efficiency of the appeals and enrollment process are closely evaluated as part of the overall plan customer experience.

In addition to an overall rating, each Medicare Advantage plan is rated in each individual category. Medicare Star Ratings are released in October of each year for the upcoming calendar year. If a plan receives a rating of fewer than three stars for three consecutive years, it becomes flagged as a low-performing plan. If the plan continues to underperform, Medicare may remove the plan entirely from the marketplace.  

To find out the ratings of plans that are available where you live, contact a licensed insurance agent at   TTY Users: 711 (24 hours a day, 7 days a week) or request more information online.

Finding the Right Medicare Advantage Plan

The star rating system provides an overall glimpse at which Medicare Advantage plans are deemed to be “the best.” But a plan’s star rating doesn’t necessarily determine whether or not a plan will work for you. Everyone has different needs, and the right plan for one person may be quite different than the plan that fits someone else’s needs.

By following the five-step process below, you may be able to better determine which Medicare Advantage plan may be the right fit for you.

Step 1: Check the plans available in your state

One thing to note while shopping for a Medicare Advantage plan is that not all plans are available in every state. For example, California had 186 plans available in 2018, while Wyoming only had three available Medicare Advantage plans.1 Plan selection can vary greatly from one state to the next, and not surprisingly, Medicare Advantage enrollment rates can vary widely between states.

When shopping for a Medicare Advantage plan, you should find out which plans are available where you live. A licensed insurance agent can help you do just that.

Step 2: Check your eligibility

Medicare Advantage plans require applicants to already be enrolled in both Medicare Part A and Part B, and most plans might typically do not offer coverage to people who have end-stage renal disease (ESRD). You also need to live within the service area of the plan you want to purchase.

It may be helpful to consult with an insurance agent to make sure you are eligible for your desired Medicare Advantage plan.

Step 3: Determine which type of plan you would like

Medicare Advantage plans come in several types, and you may want to consider the structure of a given plan to determine if it’s best for your situation. Some of the Medicare Advantage plan types include: 

  • Health Maintenance Organization (HMO)
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  • Preferred Provider Organization (PPO)
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  • Private Fee-For-Service (PFFS)
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  • Special Needs Plans (SNP)
  •  
  • HMO Point-of-Service (HMO POS)
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  • Medical Savings Account (MSA) 

Learn about how each type of plan works and decide which plan type may be best suited for you.

Step 4: Check the star ratings

Once you have found out which plans are sold in your area, confirmed your eligibility and determined which type of plan you’d like to enroll in, it’s time to review the Medicare Star Ratings.2 When doing so, you may want to take note of the categories that are important to you. 

For example, a plan may have received a four-star overall rating but only received two stars for its management of chronic conditions. If you have a chronic condition, you may want to consider a plan with a stronger rating in this area. A licensed insurance agent can share the star ratings with you for each plan sold in your area.

Step 4: Review the benefits

By law, Medicare Advantage plans must provide at least the same level of coverage as Original Medicare (with the exception of hospice care coverage, which you continue to receive through Medicare Part A). Beyond that minimum requirement, Medicare Advantage plans may then offer additional benefits that can help distinguish one plan from the next.

Some common extra benefits offered by some Medicare Advantage plans include things like prescription drug coverage, dental, vision and hearing benefits. 

Some Medicare Advantage plans may also offer perks such as gym memberships, and the list of federally approved Medicare Advantage plan benefits is set to potentially grow even more in 2019. When shopping for the best Medicare Advantage plan for you, you may want to consider these extra benefits and find one that offers services you are most likely to utilize.

Step 5: Review costs

A monthly premium is only one of the potential costs associated with Medicare Advantage plans. Medicare Advantage plans may have deductibles and out-of-pocket spending limits, along with cost-sharing measures such as copayments or coinsurance.

When deciding which plan may be best for you, you may want to carefully consider all costs associated with the plan and determine how well it will work within your budget.

Enrolling in a Plan

Find out which Medicare Advantage plans are considered the best by the CMS — and determine which plan might be best for you individually — as you take your first steps toward enrolling in a plan that fits your needs. 

Read more about Medicare Advantage enrollment, or contact a licensed insurance agent today at   TTY Users: 711.

 

1 Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org.
2 Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.