How to Compare Medicare Advantage Plans

If you’ve decided that a Medicare Advantage Plan is the right option for you, the next step is to find a policy that meets your medical and financial needs. Considering the wide range of policies available, it can be challenging to compare Medicare Advantage Plans.

In 2022, there are more than 3,800 Medicare Advantage Plans for Americans to choose from — more than any previous year. On average, a beneficiary has access to 39 Medicare Advantage Plans for individual enrollment in their service area. Keep in mind that this varies by location — depending on where you live, you could have significantly less coverage options.

It’s important to find a plan that makes the most sense for your particular situation. Read on for tips on how to compare Medicare Advantage Plans and narrow your choices.

Medicare Advantage, also known as Medicare Part C, is delivered through private insurance companies under contract with Medicare. These plans must cover the same benefits available through Original Medicare, including:

• Inpatient care in a hospital, skilled nursing facility, or home health (Part A)
• Medically necessary and preventive services, such as physician visits, tests, screenings, and flu shots (Part B)

Insurance providers then have the flexibility to offer a combination of additional health-related benefits, such as prescription drugs, dental, vision, and hearing.

Here are common supplemental benefits available through Medicare Advantage plans and the percentage of plans offering them in 2022:

• Eye exams and glasses (98%)
• Fitness (97%)
• Hearing exams and/or aids (95%)
• Dental cleanings (94%)
• Prescription drugs (89%)
• Meal benefits, including meal delivery, cooking classes, or nutrition education (67%)
• Non-emergency transportation (38%)
• Bathroom safety devices (8%)
• In-home support (10%)
• Telemonitoring (3%)
• Support for caregivers (3%)

Choosing the right plan requires a careful comparison of costs and how often you expect to need the benefits. For example, plans with low or no monthly premiums may have higher cost-sharing when you do use a service.

What are the costs of Medicare Advantage Plans to consider? Here’s a breakdown of typical out-of-pocket expenses you may need to pay:

• Monthly Plan B premiums must still be paid to Medicare, even if you’re enrolled in a Medicare Advantage plan.
• Additional monthly premiums may be payable to your private insurer. Some plans have no monthly premiums.
• Deductibles are the costs you’re required to pay before the plan pays. There may be an annual deductible and additional deductibles for certain services.
• Coinsurance is the percentage of a claim you must pay.
• Copayments are the fixed amounts you pay per service or treatment.

All Medicare Advantage Plans are required to have an annual limit on out-of-pocket costs. Once you’ve reached this limit, you can’t be charged any additional costs.

There are also types of Medicare Advantage Plans that determine how you receive your health care services. Because this may affect what doctors or hospitals you can use, it’s important to understand how each plan works.

A health maintenance organization (HMO) plan provides patients with access to a network of health care providers under contract with the insurance company. If you use a provider outside of this network, you may have to pay the full cost yourself. HMO plans typically require you to choose a primary care doctor who coordinates your care and determines if you may receive a referral to see a specialist.

Preferred provider organization (PPO) plans also have a network of providers that agree to provide services to plan subscribers. Patients may see any health care provider, but costs are generally lower when using a provider within the PPO’s network.

Typically, PPOs allow more freedom than HMOs in how you receive care. They don’t require you to have a primary care doctor, and you may see any doctor or specialist you choose without a referral.

Private Fee-for-Service (PFFS) plans establish the rate they’re willing to pay for medical services. Plan members may see any Medicare-approved doctor in the United States who accepts these rates. Patients should always confirm they can use the PFFS plan before receiving treatment as some providers may accept the rate for some services and not others.

Generally, PFFS plan members aren’t required to have a primary care doctor and don’t need a referral to see a specialist. Some plans may have a network of physicians to make it easier for you to locate a health care provider.

Special Needs Plans (SNPs) restrict enrollment to individuals who have certain chronic medical conditions. These plans provide coordinated care and benefits tailored to the enrollees’ needs and often work with doctors who specialize in the condition. Some of the medical diagnoses covered by SNPs are end-stage renal disease (ESRD), chronic heart failure, dementia, and HIV/AIDS.

There are also SNPs for those who:

• Live in an institution, such as a nursing home
• Require nursing care at home
• Have both Medicare and Medicaid coverage

Medicare Advantage Plans can make sense if you’d like health insurance beyond Original Medicare Parts A and B. Keep in mind that plans vary significantly in terms of:

• Benefits
• Out-of-pocket costs
• How health care is delivered

Here are questions to consider when comparing Medicare Advantage Plans:

• How much are monthly premiums?
• What portion of costs do you have to pay before the plan begins coverage, also known as the deductible?
• How much of the cost of a doctor’s visit or hospital stay are you required to pay?
• What is the plan’s cap on annual out-of-pocket costs? What qualifies as an out-of-pocket cost?
• Does your current doctor accept the plan? If not, are you willing to switch doctors? Which doctors near you accept the plan?
• Do you want a choice in health care providers, or are you satisfied using a preapproved network of physicians and hospitals?
• Can you receive health care outside of your service area aside from emergencies?
• Can you see a specialist without a referral?
• Do you want the ability to coordinate your own care, or do you want a primary doctor?
• What types of supplemental benefits are important to you? What are the plan’s policies regarding accessing these benefits?
• Are your current prescription drugs covered under the plan? What is your out-of-pocket cost?
• Is the plan well-rated by Medicare?

Remember, not all types of plans are available in every service area. Visit the Medicare website for a handy online tool to compare Medicare Advantage plans.