Summary: Medicare Advantage plans are a popular way for Medicare beneficiaries to get their Original Medicare (Part A and Part B) coverage as well as other benefits. There’s no “best Medicare Advantage plan” for everyone. But there’s a lot of variety among plans when it comes to extra benefits.
Medicare Advantage plans are a popular way to get your Original Medicare benefits. The Kaiser Family Foundation (KFF) estimated that 22 million people enrolled in Medicare Advantage plans in 2019. That number made up about one-third of all Medicare beneficiaries. Many people shop for the best Medicare Advantage plan for their particular needs.
Your Medicare Advantage plan will cover everything that Original Medicare (Part A and Part B) covers. The only exception is hospice care, which Part A still covers. When comparing the best Medicare Advantage plans for you, look at the plan type, coverage, and cost. Keep in mind that not all Medicare Advantage plans are available in all areas.
Choosing the best plan for you involves comparing plans in your service area. There are different factors to consider, including plan type, coverage options, and the overall cost of the plan.
Choosing the best Medicare Advantage plan for you: types of plans
There are several different types of Medicare Advantage plans. Some of the more common plans are:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs*)
- Private Fee-For-Service Plans (PFFs)
- Special Needs Plans (SNPs)
These plan types are similar to the ones offered by employers.
Health Maintenance Organization (HMO) – These plans generally require you to select a primary care doctor and get a referral to see a specialist. You generally need to see providers in the plan’s network.
Preferred Provider Organization (PPO) – A PPO may let you see any doctor or hospital that accepts Medicare assignment. Usually, the plan charges less to use doctors and hospitals in the plan’s network. You won’t need a referral to see a specialist. That means you can schedule an appointment with a specialist like a dermatologist without having to contact your primary doctor first
Private Fee-for-Service (PFFS) – You may not need to choose a primary care physician, and you might not need a referral to see a specialist. Just be aware that not all Medicare providers accept the plan’s payment terms.
Special Needs Plan (SNP) – This plan type is for people in specific circumstances. For example, if you live in a nursing home or you have a severe or disabling chronic condition, you might qualify for this type of plan. The plan may tailor benefits to the needs of the people it serves. Read more about Medicare Special Needs Plans.
Choosing the best Medicare Advantage plan for you: extra coverage details
Medicare Advantage plans must provide the same coverage as Medicare Part A and Part B. Many plans may also cover services Medicare Part A and Part B typically don’t cover. Here are just a few examples.
Would the best Medicare Advantage plan for your needs cover medications? You might be pleased to hear that most Medicare Advantage plans include prescription drug coverage.
Every Medicare Advantage prescription drug plan has a formulary. This is a list of the medications covered under the plan. The coverage may include different pricing or tiers for different medications. If the plan you want has different tiers, make sure the medications you take are affordable for you.
Routine dental services
If you want your dental care covered, perhaps the best Medicare Advantage plan for you would include routine dental services. Many Medicare Advantage plans cover preventative care, such as exams, cleanings, fillings, tooth extractions and x-rays.
Other services and items
As you think about what may be the best Medicare Advantage plan for you, think about the additional benefits would be important to you. Some plans might cover:
- Routine hearing services and hearing aids
- Routine eye exams and eyewear
- Fitness programs
- Home safety devices
- Over-the-counter medications
These are just a few examples of what Medicare Advantage plans might cover. Different plans may cover different services – that’s what it’s good to compare plans to find the best Medicare Advantage plan for you.
Choosing the best Medicare Advantage plan for you: out-of-pocket costs
Medicare Advantage plans may have different costs. When you’re searching for the best Medicare Advantage plan for you, it’s important to look at all the costs – not just premiums. Some of the costs might include:
One cost for a Medicare Advantage plan is a monthly premium. Some Medicare Advantage plans offer a $0 monthly premium, but with all plans you must continue paying your Medicare Part B premium. The best Medicare Advantage plan for you might not be the one with the lowest premium. Consider other costs, such as copays, coinsurance, and deductibles.
Copayment or coinsurance
A copayment is usually a set dollar amount you pay when you receive a specific medical service. Coinsurance is a percentage (such as 20%) of the total cost of a doctor visit.
Different Medicare Advantage plans may charge different copayments or coinsurance amounts. If you have a PPO plan, the plan may charge you a higher copayment or coinsurance for a visit to a doctor out-of-network. Preventative services may come with a $0 copayment with some Medicare Advantage plans.
Some services you may have to pay a copayment or coinsurance for are (this list may not include every service):
- Emergency room visits
- Ambulance services
- Outpatient surgery
- Outpatient rehabilitation services
- Skilled nursing facility
Some Medicare Advantage plans have an annual deductible. This is an amount you must pay out of pocket before your plan begins to pay.
Every Medicare Advantage plan has an annual out-of-pocket maximums. This is a maximum amount that you pay in a year before the plan begins to pay 100% of your health-care costs. If you expect to use medical services a lot, your best Medicare Advantage plans may be those with lower maximums.
What is the best Medicare Advantage plan for me?
When choosing the best Medicare Advantage plan for you, think about what’s important to you.
- Access to your preferred primary care doctors, specialists and hospitals?
- Routine dental coverage?
- Coverage for fitness programs?
- Disease management benefits?
Remember, these are just a few of the possible extra benefits Medicare Advantage plans might offer.
To find the best Medicare Advantage plans for you, it is important to look at all three of these factors. The right plan will fit both your medical needs and your current budget. Keep in mind plans can change every year, so review your plan to make sure it’s still the best choice for you.