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How do I choose the best Medicare Advantage plan for my needs?

En español  |You must evaluate several areas because Medicare Advantage, also known as Part C, is an all-in-one alternative to original Medicare.

Private insurance companies offer Medicare Advantage plans that Medicare approves. And they bundle together coverage for two to three of the other parts of Medicare:

Medicare Advantage plans may have some coverage for services not included in original Medicare, such as dental, hearing and vision care.

If you choose to get Medicare coverage from a private insurer through a Medicare Advantage plan, you’ll generally have several plans to choose from in your geographic area. The average Medicare beneficiary has 39 Medicare Advantage plan choices in 2022, according to the Kaiser Family Foundation. The premiums, copayments for medical and drug coverage, covered drugs, and provider networks can vary from plan to plan.

When choosing a plan, consider costs and coverage for your typical medical needs and prescription drugs, coverage for major medical issues, and which providers and facilities are included in the plan’s network. You can find out more about the costs and coverage for all of the Medicare Advantage plans available in your area by using Medicare’s Plan Finder.

Consider the following questions when choosing a plan:

How does a Medicare Advantage plan cover my drugs?

To find out about each plan’s coverage for your medications, type your zip code into the Plan Finder. Then under Plan Type, click the circle next to Medicare Advantage Plan and scroll down to hit the Apply button. If your zip code spans more than one county, you’ll have to click the circle next to yours.

Then hit the Start button. After answering a question or two, make sure you choose Yes to see your drug costs when comparing plans. Then you can either add your drugs and dosages or use the information from your online Medicare account. You can also select nearby pharmacies you use.

You’ll get a list of plans in your area, which shows the Monthly premium and Yearly drug & premium cost specifically for your medications. A plan with little or no premium may end up being more expensive if it charges large copayments for your medications.

You can click on the drop-down menu at the top of the page to sort the plans by Lowest drug + premium cost and other criteria. Click on the Plan Details button for each plan to get more information about copayments and monthly costs for the drugs on your list. You'll also see when you’ll enter and leave the coverage gap, based on the costs of your drugs.

How does a plan cover my typical care, big medical issues?

The Plan Finder can show you copayments for various services. Click on Plan Details and scroll down to Benefits & Costs — or click the Benefits & Costs tab to do the same thing — to see copayments for primary doctor and specialist visits, lab services, X-rays, diagnostic radiology services such as MRIs, emergency care, inpatient and outpatient hospital coverage, physical therapy and other services.

Also look at the plan’s out-of-pocket spending limit. In 2022, the maximum out-of-pocket spending limit, which includes copayments and deductibles for medical care but not premiums or drug costs, must be $7,550 or less for in-network care, and $11,300 for covered in-network and out-of-network care. Some plans have lower limits.

Does a plan cover doctors, facilities, other providers I want?

Most Medicare Advantage plans have provider networks, so you’ll need to find out whether the doctors, hospitals and outpatient clinics you want to use are covered. The Plan Details page in Plan Finder may include a link to the plan’s provider network. If so, search or scroll down to Provider Costs.

In many cases, that link goes to the plan’s website, where you may find a searchable provider database. After you narrow the possibilities, you should call a plan’s customer service number and ask your doctors whether they participate in the plan or plans you’re interested in to reconfirm what you saw online. 

Be sure to ask about a specific plan by name. Some Medicare Advantage insurers offer several plans with different provider networks.

Also find out how your Medicare Advantage plan will treat your use of an out-of-network provider:

  • Some health maintenance organizations (HMOs) pay nothing for out-of-network providers except for emergencies.

  • Some preferred provider organizations (PPOs) cover out-of-network providers, but charge higher copayments and have higher out-of-pocket spending limits for out-of-network care.

This is important to know if you end up wanting to see a specialist that’s not in the plan’s network or if you travel and need to go to a doctor while away from home. The Benefits & Costs section for each plan on Plan Finder lists the in-network copayments for each type of care and the out-of-network copayments if covered.

Does the plan offer other coverage I’m interested in?

Many Medicare Advantage plans offer some coverage for dental, hearing and vision care. Some plans offer additional benefits, such as a gym membership, in-home safety devices and transportation to medical appointments. A plan may offer special coverage for chronic conditions.

Click on Plan Details for more information about extra benefits, such as copayments and coverage for dental, hearing and vision. You can click on Plan Website at the top of a plan’s page on Plan Finder for a link to more details about a plan’s coverage.

How does the plan rate for customer service?

The Centers for Medicare & Medicaid Services rates Medicare Advantage and Part D plans based on several quality measures. Five stars are the best.

For Medicare Advantage plans, here are the main categories for the health plan quality rating:

  • Staying healthy: screenings, tests & vaccines
  • Managing chronic (long term) conditions
  • Member experience with health plan
  • Member complaints and changes in the health plan’s performance
  • Health plan customer service

If the Medicare Advantage plan includes prescription drug coverage, it will also have drug-plan star ratings in several categories:

  • Drug plan customer service
  • Complaints and changes in the drug plan’s performance
  • Member experience with the drug plan
  • Safety and accuracy of drug pricing

You can find a plan’s star ratings in the Plan Finder. Click on Plan Details and scroll down to the bottom or click the Star Ratings tab. You’ll see a plan’s overall star rating, as well as a breakdown of the rating for each of the categories and subcategories.

Keep in mind

At several points after you sign up for Medicare Parts A and B, you can choose a Medicare Advantage plan. You must be enrolled in both before you can enroll in an Advantage plan:

  • When you first enroll in Medicare during your initial enrollment period
  • If you qualify for a special enrollment period because of a move out of a plan’s service area, for example
  • During open enrollment, which runs Oct. 15 to Dec. 7 each year, with new coverage starting Jan. 1
  • During the yearly Medicare Advantage open enrollment period, Jan. 1 to March 31, that allows people with a Medicare Advantage plan to switch to another Advantage plan or leave and return to original Medicare.
  • All year, if an overall five-star Medicare Advantage plan is what you want and one is available in your area. Technically, the five-star special enrollment period does not include the first week in December, but that is the final week of open enrollment.

You can enroll in a Medicare Advantage plan through the Plan Finder. Click on the Enroll button and follow the prompts.

Or find a plan’s website and nonmember phone number under the plan name’s name and ID in Plan Finder. Then you can go to the plan’s website or call to enroll directly. 

To get additional help comparing and enrolling in a plan, contact your federally financed State Health Insurance Assistance Program.

Updated July 27, 2022

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