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What are Medicare Advantage Plans?
Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are a private healthcare alternative to Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.. As of the 2022 plan year, the program provides healthcare for close to half (48%) of all eligible Medicare beneficiaries.
Medicare Advantage plans are local. Each plan is designed for the specific needs of its local residents and the availability of local healthcare providers. The easiest way to shop and compare 2023 plans where you live is to enter your zip code in the search tool above. You can also browse by state using the links below.
If you are new to Medicare and want to understand if Medicare Advantage is the best option for you and your personal situation, keep reading below.
Browse Top-Rated Medicare Advantage Plans by State
What Every Medicare Beneficiary Needs to Know About Medicare Advantage
Medicare Advantage, Part C of Medicare, is a private health insurance option for Medicare beneficiaries. Each year, health insurance companies offer new plans or update their existing plans in the counties they serve. Medicare Advantage plans, like most Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans, don’t give you nationwide coverage. Except in an emergency, coverage is regional.
People who choose Medicare Advantage vs. Original Medicare generally do so because they get more benefits. The key advantage to private health plans is their ability to offer more services, including prescription drug coverage, dental, vision, hearing, transportation services, and more.
How Does Medicare Advantage Work?
When a Medicare A person who has health care insurance through the Medicare or Medicaid programs. chooses to enroll in a Medicare Advantage plan, the plan takes over responsibility for the member’s healthcare coverage. In other words, the Centers for Medicare & Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. Services (CMS) is no longer the primary payor for the beneficiary’s care.
As you prepare to compare plans, it’s important to understand that all Medicare Advantage plans must provide all of the coverage guaranteed by Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services.. However, plans are not required to cover benefits in the same way. For example, Part A and Part B (e.g., Original Medicare) are private fee-for-service coverage. Medicare pays approximately 80 percent of all covered services, and the beneficiary pays the remainder as an out-of-pocket cost or with supplemental insurance (e.g., Medigap).
With Medicare Advantage plans, members pay monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. and A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. when they use services. Depending on a member’s use of healthcare services, their costs may be more or less than 20 percent.
What are the Advantages and Disadvantages of Medicare Advantage Plans?
It’s understandable why most people with Medicare would want to know the disadvantages of Medicare Advantage plans. After all, the advantage is easy to see. Plans are able to offer more services than Original Medicare. But, how do you quantify advantages and disadvantages when comparing plans?
It isn’t easy.
There are many potential disadvantages to these plans. Most are subjective. Some of these may include:
- Most private insurance companies that offer Medicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all... plans use network providers to cover a service area. This might be a disadvantage if your doctor or specialist is not in the plan’s network of healthcare providers.
- Most HMO plans require members to get a referral from their primary care doctor to use healthcare services (except emergency care).
- Most types of Medicare Advantage plans have copays or Coinsurance is a percentage of the total you are required to pay for a medical service. when a member uses services. Original Medicare also has a coinsurance requirement (20%), but Medicare Advantage plan copayments can cost more.
What is the Difference Between Medicare Advantage and Medicare Supplement Insurance?
When comparing Medicare Advantage with a Medicare Supplement, it’s important to remove the fluff and look at the hardcore facts. Major healthcare, which is what Original Medicare covers, is very expensive. So, make sure those costs are covered as completely as possible within a budget you can afford.
One difference between Medicare Advantage and Original Medicare plus a Medicare Supplement is when you pay. With Medicare Advantage, you pay most of the costs at the point of service. As a result, costs can vary and be difficult to plan for in advance.
With Original Medicare and Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., you pay many of your costs up-front through monthly premiums. As a result, your medical costs may be easier to plan and budget.
How Much Do Medicare Advantage Plans Cost?
Most people who join a Medicare Advantage plan do so because there is a cost-benefit. Generally, the cost-benefit comes from a low monthly premium combined with additional benefits bundled with a plan.
There is a general misconception that Medicare Advantage plans cost less than Original Medicare. This isn’t always true. In fact, studies show that an inpatient stay in the hospital is likely to cost more with a Medicare Advantage plan, not less.
For this reason, it is very important to do your homework and examine costs when you use healthcare services with a plan. Every plan publishes a summary of benefits document that details all costs. MedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. publishes the summary of benefits information on all plan pages. You can download it as a PDF document to easily compare plans.
When Can I Enroll in a Medicare Advantage Plan?
Unlike Medigap, which does not have a specific enrollment period, you are only allowed to enroll in a Medicare Advantage (MA) plan or Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan (PDP) during specific Enrollment periods are designated time periods to enroll or disenroll from the various parts of Medicare. There are six Medicare enrollment periods., which include your Individual Enrollment Period (IEP), the Annual Election Period (AEP), the The General Enrollment Period (GEP) allows beneficiaries to enroll in Medicare Part A and Part B from January 1 to March 31 if they missed their Initial Enrollment Period. Beneficiaries can also enroll in a... (GEP), and the Medicare Advantage During the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31. (OEP). It’s critical that you mark these In health insurance, open enrollment is a period during which a person may enroll in or change their selection of health plan benefits. Health plan enrollment is ordinarily subject to restrictions. period dates on your calendar:
- IEP – A 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
- AEP – Starts October 15 and ends December 7. During AEP you can dis-enroll from your existing Medicare Advantage or Part D plan.
- GEP – Starts January 1 and ends March 31. If you did not get enrolled during your IEP, you can sign up for Part A and/or Part B during this time.
- OEP – Starts January 1 and ends March 31. During this time individuals enrolled in a Medicare Advantage plan can make a one-time election to go to either another Medicare Advantage plan with or without prescription drug coverage or Original Medicare.
In certain circumstances, Medicare may also grant a Special Enrollment Periods (SEPs) allow beneficiaries to change their Medicare Advantage and Part D plans due to a special circumstance. Common reasons for a SEP include moving, losing employer coverage, and Medicaid eligibility, to name... (SEP). An SEP is generally approved for specific life circumstances, such as moving out of your plan’s service area.
If you’re considering keeping your Original Medicare coverage and supplementing with additional coverage, the best time to buy a Medicare Supplement plan is during the six-month enrollment period that starts the first day of the month you turn age 65 — as long as you have enrolled in Medicare Part B.
If you are newly eligible for Medicare because you’re disabled and under 65, you can sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan starting 21 months after you get Social Security. Your Medicare coverage begins 24 months after you get Social Security. Your chance to enroll in an MA plan lasts through the 27th month after you get Social Security benefits.
Are Medicare Advantage plans Really an Advantage?
If you’ve read this far, you might be wondering, is Medicare Advantage worth it? Medicare Advantage private health plans may be a good option for the following people:
- People with retiree benefits help pay Medicare Advantage premiums, A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., and copays.
- People who qualify for a Medicare Advantage Special Needs Plan.
- People who are exceptionally healthy and rarely use healthcare services outside of their annual wellness visits.
- People who can’t get a Medicare Supplement due to one or more chronic health issues and need the maximum Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. safety net built into Medicare Advantage plans.
- People seeking additional benefits and typically incur significant costs for things like dental, vision, hearing, and healthcare transportation.
- People who need prescription drug benefits, in addition to their Original Medicare coverage, that prefer an all-in-one solution.
If you fall into one of the above categories, then yes, we recommend taking the time to compare the plans available in your area.
How to Compare Medicare Advantage Plans
One of the minor disadvantages of Medicare Advantage is that plans can be difficult to compare and plans can change every year. The Original Medicare system, with supplemental coverage through standardized Medigap plans, typically has fewer changes.
To compare Medicare Advantage plans we recommend looking at four things:
- Copayments and Coinsurance. Every service has its own costs that the member pays when they use the service. These costs are spelled out in a plan’s summary of benefits document. MedicareWire shows the summary of benefits information on plan pages.
- Maximum Out-of-Pocket (MOOP) Cost. This is the maximum you will pay out-of-pocket on deductibles, copays, and coinsurance in a plan year before the plan begins paying 100 percent. It does not include your monthly premiums or prescription drug (Medicare Part D) costs. MOOP only includes Part A and Part B covered services that you receive from Doctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... providers.
- Monthly Premiums. When you join a Medicare Advantage plan you will pay the plan’s premium and you must continue to pay your Medicare Part B premiums. Many plans have a zero-dollar premium, which simply means the Part B premium covers the full cost.
- Star Ratings. Every year, Medicare evaluates plans on a 5-star rating system. The star ratings help members understand the quality of care and service they can expect.
Types of Medicare Advantage Plans
There are several different types of Medicare Advantage plans:
- HMO — Medicare Advantage HMOs provide care through a network of doctors, hospitals, and other medical professionals that you must use to be covered for your care.
- PPO — PPO plans, like HMOs, have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. However, with a Medicare Advantage PPO, you are not restricted to using providers in the network
- HMO-POS — With a Medicare Advantage HMO-POS you have the option to go outside of the network for care, but you’ll pay more when you do. Also, The HMO and POS portions of the plan have separate deductibles. Care you receive in-network through the HMO has a different deductible than the care you get out-of-network through the POS.
- COST — Medicare Cost Plans are a type of Medicare health plan available in certain, limited areas of the country. Unlike other plans, you can join even if you only have Part B. If you have Part A and Part B and go to a non-network provider, Original Medicare covers the services. You’ll pay the Part A and Part B coinsurance and deductible. Also, you can get your Medicare drug coverage from either the plan or you can join a Medicare Part D plan.
- PFFS — A Medicare Advantage PFFS plan sounds a lot like Original Medicare and Medigap, but it’s not. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care. You can go to any Medicare-approved doctor or hospital that accepts the plan’s payment terms and agrees to treat you.
- MSA — Medicare Advantage MSA plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.
- SNP — Medicare Advantage Special Needs Plans (SNPs) are most commonly HMO and PPO plans designed to provide healthcare to people with special health, financial, or institutional needs. Due to their specialization and qualification requirements, MedicareWire organizes SNP plans in its own directory.
NOTE: Although a plan may use provider networks to deliver care, emergency care is always covered both in and out of the provider network.
What is the Best Medicare Advantage Plan?
With Medicare, one size does not fit all. What’s best for your neighbor may not be the best choice for you. The only way to figure out which Medicare Advantage plan is best is to look at your unique personal needs.
For many people, Medicare Advantage offers a combination of the best cost and the best coverage. For instance, people with employer retiree benefits that assist them with copayments and deductibles love Medicare Advantage. The same is true of most people with Dual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... status (e.g., Medicare and Medicaid) in counties that offer SNP-D (Special Needs Plans for dual-eligible people) plans.
However, if you don’t have financial assistance from a former employer or your state, Original Medicare, not Medicare Advantage, might be a better option. Even though most private health plans offer more coverage options than Original Medicare, those options could end up costing you a lot more money.
How To Choose The Best Medicare Advantage Plan
People often want to know, who has the best Medicare Advantage plan. Or, what is the highest-rated Medicare Advantage plan? Medicare’s star ratings provide a clear-cut answer for the highest rates plans. But, there’s more to it than that.
Finding the best Medicare Advantage plan takes a little legwork. It’s important to understand that plans are regional, not national. As a result, a plan your friend has and loves in the next county over from you may not be available where you live. You must research plans in your region.
Plan Benefits That Go Beyond Original Medicare
From its inception, Original Medicare was designed to cover major medical services. Medicare Advantage plans also cover major medical, but insurance companies are free to bundle extra benefits with their health insurance, as well. The most common benefit included is a prescription drug plan. However, an increasing number of plans also offer routine care for dental, vision, hearing, and more.
Another additional benefit that’s quickly becoming a popular option, particularly in the age of the COVID-19 virus, is telehealth. This is a great option for anyone, but it’s particularly beneficial if getting to your doctor’s office is inconvenient.
Speak with a Licensed Insurance Agent
Ready to enroll? Still have questions? It’s time to speak with a licensed insurance agent.
You can enroll through the plan itself, using one of its agents, or use an independent agency like HealthCompare. Your cost will be the same, regardless.
Call 1-855-728-0510 (TTY 711) to speak with a licensed advisor.
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Citations & References
- 1. KFF.org, Medicare Advantage in 2022: Enrollment Update and Key Trends, Last Accessed October 19, 2022
- 2. Medicare.gov, How do Medicare Advantage Plans work?, Last Accessed October 13, 2022
- 3. Medicare.gov, How to join a Medicare Advantage Plan, Last Accessed October 11, 2022
- 4. KFF.org, Medicare Advantage in 2022: Premiums, Out-of-Pocket Limits, Cost Sharing, Supplemental Benefits, Prior Authorization, and Star Ratings, Last Accessed November 5, 2022
The content on this page is maintained by David Bynon and was last updated on .