Medicare Advantage plans are organized and sold county-by-county. The reason for this, versus national plans, is that most private health insurance use provider networks, which are local.
So, the answer to a simple question, like, “Who Has the Best Medicare Advantage Plan?”, or “What are the top 3 Medicare Advantage plans?”, will be different depending on where you live. For this reason, we’ve done our best to organize and catalog Advantage plans to show you the best plans visually using the Center for Medicare & Medicaid Services star ratings. All you have to do is enter your zip code in the box below to get started. We make comparing Medicare Advantage plans easy.
How Are Medicare Advantage Plans Different From Original Medicare?
Original Medicare is a private fee-for-service system. Approved healthcare providers (e.g., doctors, hospitals, nursing homes, etc.) agree to accept a set payment for their services. Medicare pays about 80 percent of Medicare-approved costs. The beneficiary pays the remaining 20 percent for their Medicare coverage.
Although all Medicare Advantage plans agree to provide the same Medicare-approved services included in Medicare Part A and Part B, they are not required to cover them in the same way. Specifically, a plan can charge you both a monthly premium to be in the plan and copayments when you use health services. Also, a plan can mandate that you get a referral to use various healthcare services (i.e., specialists, lab tests, diagnostics, etc.). Referrals are not required for wellness visits or when you need to see your primary care physician. You also do not need a referral for a hospital stay due to an emergency or to go to urgent care.
Aside from the cost and control differences cited above, another big difference is the extra benefits insurance companies can add to their plans. One of the top benefits plans add is prescription drug coverage (Medicare Part D plan). Other popular benefits include routine dental, vision, and hearing. Some plans even offer SilverSneakers as one of their additional benefits so their members can stay fit.
On the plus column for Original Medicare, you don’t have to deal with open enrollment when you have Part A and Part B coverage, and there are no network providers or service area restrictions within the USA.
RELATED: What Does Medicare Advantage Cover?
Do I Still Need Medigap Insurance?
Medicare Advantage is an alternative to Original Medicare and a Medicare supplement (Medigap). The two types of insurance are not compatible. If you enroll in a Medicare Advantage plan, you will automatically be disenrolled from Medicare Part A and Medicare Part B. At the same time, if you have a supplement, the insurance carrier will be notified and will cancel your policy.
What is Medicare Part C?
Medicare Part C is another name for Medicare Advantage. There’s no difference between Part C plans and Medicare Advantage plans.
What Are Medicare Advantage PPO Plans?
Preferred Provider Organization (PPO) plans are one of the most common types of Advantage plans. The other common plan type is a Health Maintenance Organization (HMO) plan. Most people choose one of these two types of Medicare Advantage Plans.
Both Medicare Advantage HMOs and PPOs use network providers. The difference is that with an HMO you must use the plan’s network. However, with a PPO you have the option to use a provider that’s not in the network, but you’ll pay more in out-of-pocket costs (e.g., copayments or coinsurance). With HMO plans, you must use the provider network.
Another type of plan that’s gaining popularity is PFFS plans (private fee for service) plan. They are not the same as Original Medicare coverage with a Medicare supplement plan, but they do offer a lot of flexibility. And, for people with excellent health who want full control, there are Medicare MSAs (medical savings account) insurance plans, too.
RELATED: What are Medicare Advantage Plans?
Can Medicare Advantage Plans Be Compared to Medicaid?
No, not really. However, there is a special type of plan, called Special Needs Plans (SNP), specifically designed for people who qualify for both Medicare and Medicaid. These plans are organized by the county and are offered by some of the biggest names in health insurance, including UnitedHealthcare, Humana, and Aetna, to name a few. If you have the option to get an SNP, do it! For those who qualify, it’s like getting free Medicare supplement insurance. You pay very little to see your doctor.
How Do I Enroll in a Medicare Advantage Plan?
Getting enrolled is easy. Once you know which plans you’re interested in, it’s time to get on the phone with a licensed insurance agent. MedicareWire recommends HealthPlanOne, the nation’s largest and most respected Medicare insurance agency. In fact, many insurance companies use HealthPlanOne for their enrollment services. You can reach them by calling 1-855-266-4865.
Citations & References:
- Find a Medicare plan
- Medicare Advantage Plans | Medicare
- Medicare costs at a glance | Medicare
- Trump Administration Drives Down Medicare Advantage and Part D Premiums for S…
- Part C and D Performance Data | CMS
This article was written by David Bynon, and was last updated on .