En español | You first should know how Medicare Advantage, also known as Part C, works. Private insurance companies sell Medicare Advantage plans as an all-in-one alternative to original Medicare that is approved by Medicare. The plans bundle together coverage for two or three parts of Medicare:
- Part A, hospital stays.
- Part B, doctor and outpatient services.
- And usually, Part D, prescription drugs.
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 43 Medicare Advantage plan choices in 2023, 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 the plan’s network includes. You can find out more about the costs and coverage for all 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, go to the Plan Finder and log into your online Medicare account. Refer to your saved list of medications and pharmacies to compare plan costs and coverage.
The other option is to go to the Plan Finder and continue without logging in. Type your zip code, then under Plan Type, click the circle next to Medicare Advantage Plan and scroll down to the Apply button.
You’ll need to identify if you receive help with your costs from government programs before you can start adding your drugs, dosages and 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 Plan Details for each plan to learn about copayments and monthly costs for the drugs on your list.
How will an MA plan cover all my health care needs?
The Medicare Plan Finder outlines copayments for various services. Click on Plan Details and then Benefits & Costs to see copayments for primary doctor and specialist visits, diagnostic tests, lab services, diagnostic radiology services such as MRIs, X-rays, emergency care, inpatient and outpatient hospital coverage, physical therapy and other services.
Also look at the plan’s out-of-pocket spending limit. In 2023, the maximum out-of-pocket spending limit, which includes copayments and deductibles for medical care but not premiums or drug costs, must be $8,300 or less for in-network care, and $12,450 for covered in-network and out-of-network care. Some plans have lower limits.
Will a plan cover my doctors, facilities, other providers?
Most Medicare Advantage plans have provider networks, so you’ll need to find out whether you’ll have coverage for the doctors, hospitals and outpatient clinics you want to use. Scroll down to Benefits & Costs for a link to the plan’s provider network directory.
After you narrow the possibilities, call the plan and ask your doctors to verify their participation. Ask about specific plans by name. Some Medicare Advantage insurers offer several plans with different provider networks.
Also find out how your Medicare Advantage plan will work with 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.
The Benefits & Costs section lists the plans’ 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 general information about extra benefits. Go to the plan’s website for more details.
How does the plan rate for customer service?
The Centers for Medicare & Medicaid Services gives Medicare Advantage and Part D plans star ratings based on several quality measures. Five stars is the best. You can see a plan’s overall star rating in the Plan Finder, as well as a breakdown of the rating for each of the categories and subcategories.
Keep in mind
You have several opportunities to choose a Medicare Advantage plan after you sign up for Medicare parts A and B. 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, such as moving out of a plan’s service area.
- 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 doesn’t include the first week in December, but that’s the final week of open enrollment.
To get additional help comparing and enrolling in a plan, contact your federally financed State Health Insurance Assistance Program.
Updated March 2, 2023
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