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Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. The downsides to Medicare Advantage plans are mostly related to a limited choice of providers and service area and the need to obtain prior authorization and referrals. Many resources can help you research and compare Medicare Advantage Plans offered by private insurance companies.

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What You Should Know About Medicare Advantage Plans

  • Medicare Advantage Plans are an alternative to Original Medicare.
  • With a Medicare Advantage Plan, also known as Part C, you’ll get coverage for Part A (hospital insurance) and Part B (medical insurance), and often Part D (prescription drug coverage).
  • Some Medicare Advantage Plans may include vision, dental, and other benefits.

How Do I Choose The Best Medicare Advantage Plan?

Take the time to consider what matters most to you, how you prefer to access your health care, your budget, your current provider network and healthcare needs, and what Medicare Advantage Plans are offered in your area. There are different types of Medicare Advantage Plans, so you should understand the available options in your county.

Medicare Advantage Plan types

The two most common Medicare Advantage Plan types for individuals are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

  • HMOs pay for in-network services and require you to have a primary care physician.
  • PPOs pay for in- and out-of-network services, but your costs are lower if you stay in-network.

Both types typically include a drug plan.

Other types of Medicare Advantage Plans are:

  • Medical Savings Accounts (MSAs). High-deductible plans deposit money into your MSA and typically have no network or restrictions on which providers you use. There is no drug coverage.
  • Private Fee for Service (PFFS). Plans generally allow you to receive services from any Medicare-approved provider and sometimes have a network of providers who have agreed to treat plan members. PFFS plans may have drug coverage.
  • Special Needs Plans (SNP). SNPs provide benefits and services if you have a qualifying disease, certain health care needs, or limited income.

Selecting a Medicare Advantage Plan

You can visit Medicare.gov to research your options and create an account or start your search. You will follow prompts to help you narrow down your search for a Medicare Advantage Plan.

You will enter your zip code and be asked to answer whether or not you get help with your health care costs and whether or not you want to see your drug costs. If you create an account, you can input and save your list of current medications without entering them in on each search.

Next, you can select your plan type and can apply the following filters to help you narrow down your search:

  • Plan benefits (hearing, dental, vision, transportation, fitness)
  • Specific insurance carrier
  • Drug coverage
  • Star Rating
  • Special Needs Plans (chronic, debilitating condition; dual-eligible for Medicare and Medicaid; the need for long-term care)
  • Insulin savings plan

Next, you will see a listing of plans that can be sorted by:

  • Lowest yearly drug deductible
  • Lowest health plan deductible
  • Lowest drug and premium cost
  • Lowest monthly premium cost

You will be able to scroll through a snapshot of plans available to you from different insurance carriers with easy-to-see information about monthly premiums, annual deductibles, maximum out-of-pocket costs for in-network medical care, and a list of benefits. Every plan has a button you can click on to see more detailed information. You can compare up to three plans at a time.

Once you know what is available to you, you can dig deeper to determine whether your preferred providers are in-network by continuing to access the site or by contacting your provider or the plan you are considering.

Getting Help Choosing a Medicare Advantage Plan

You can get help from a licensed Medicare insurance agent or your local Area Agency on Aging. There is a lot of information available to you from a variety of sources. Selecting a Medicare Advantage Plan can feel complicated and overwhelming, but your understanding should become clearer as you engage in the process.

The best Medicare Advantage Plan for you is the one that best fits your budget and supports what is most important to you in terms of choice of providers. The ability to receive optimal healthcare when you need it is a quality-of-life issue.

By the time you are eligible for a Medicare Advantage Plan, you most likely have had some experience with private insurance companies and are aware of your current and potential health concerns. Use this information to help you make a decision. The good news is that you can change your mind and plan at certain periods in the year as your priorities and circumstances change.

What’s the Downside to Medicare Advantage Plans?

The potential downsides to Medicare Advantage Plans are primarily related to restrictions of the service area, choice of providers, and the need to obtain prior authorizations or referrals for services, supplies, and medications. All of these limitations help to minimize costs to you, the consumer. The trade-offs are limited choice, the need to wait for prior authorizations for medications or services, or more time spent upfront trying to get advance plan approval.

  • A restricted service area may be an issue if you travel or reside in a different area of the country for part of the year.
  • The utilization of in-network providers and services keeps your costs lower but limits where you go to receive services and medications and who you can see to provide for your healthcare needs.
  • The wait time and effort necessary to obtain prior authorizations or advance plan approval for medications and treatments may feel burdensome.
  • You most likely will need a referral before seeing a specialist, who must also be in-network to keep your costs as low as possible.
  • Your copay for hospitalization may be more than what you would pay with Original Medicare if your hospital stay is longer than five or six days.

Which Insurance Companies Offer The Best Medicare Advantage Plans?

All Medicare Advantage Plans offered by private insurance companies must provide coverage for Medicare Part A and B benefits and access a comprehensive set of providers for consumers. All companies must adhere to Medicare rules and regulations to ensure your rights as a Medicare beneficiary.

Available coverage

Medicare Advantage Plans differ in how they administer benefits, including extras such as dental, hearing, and vision. As you search for the best plan for your individual needs, you will find that plans differ in how they help cover these services, but most offer at least partial coverage.

Star Ratings

One quality measurement that Medicare has established is a “Star Rating” assigned annually to each insurance company based on consumer-focused performance factors. Ratings range from 1 (poor performance) to 5 (excellent performance). These quality ratings are based on over 40 performance measures, including preventive screening coverage, good outcomes, consumer satisfaction, and timeliness of appeals decisions. Most Medicare beneficiaries are enrolled in 4 or 5 star plans.

Coverage area

Another way to look at which companies offer the best plans is to consider how large a footprint they have across the country. Good companies will continue to grow their member enrollment over time and expand their reach into more areas because they offer quality, affordable service that meets the needs of consumers and providers.

According to the Kaiser Family Foundation, UnitedHealthcare and Humana have consistently accounted for the largest share of Medicare Advantage enrollment and insure almost half of Medicare Advantage enrollees in 2021. The other companies with a market share, include BlueCross Blue Shield affiliates including Anthem, CVS Health/Aetna, Kaiser Permanente, Centene, and Cigna. All other insurers include companies with less than @% of total enrollment.

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