How to choose the right Medicare Advantage plan for you

How much are the Medicare Advantage plans?

Medicare Advantage costs vary based on the insurer, state and type of plan and coverage.

Let’s first talk about how the plan type affects costs. You’ll likely pay lower premiums for a health maintenance organization (HMO) plan than a preferred provider organization (PPO). However, HMOs, which make up about two-thirds of Medicare Advantage plans, have more restrictive networks than PPOs and you usually have to get primary care provider referrals to see specialists.

High-deductible health plans (HDHPs) have lower premiums than HMOs and PPOs, but those usually have much higher out-of-pocket costs. That means you may pay more for health care services in an HDHP.

There can be a monthly premium for Medicare Advantage plans. Any monthly premiums incurred are in addition to Medicare Part B’s standard monthly premium of $164.90 for 2023.

Many insurers offering Medicare Advantage plans don’t charge any monthly premiums. Those plans will likely have high deductibles and out-of-pocket costs, though.

Other plan aspects that influence costs are prescription drug coverage and additional benefits. The more comprehensive the plan, the more likely you’ll pay higher costs.

What’s the Medicare Advantage plan’s quality rating?

Medicare Plan Finder allows you to compare each plan’s rating. Medicare rates plans from 1-5 with 5 being the highest level.

Medicare devises these ratings on member experience, customer service and quality of care. Quality of care includes a plan’s preventive services and chronic condition management.

When comparing plans, make sure to look at both the overall quality rating and individual category rankings.

Is your doctor in the Medicare Advantage plan’s network?

Before choosing a plan, check that your physicians are considered in-network. If they’re not in your plan’s network, you’ll have to pay higher rates for out-of-network care when you visit them. You may even have to pick up the whole tab.

You can check Medicare Advantage’s online provider network, but that’s usually not enough. Studies have found that about half of provider information on Medicare Advantage’s provider network isn't complete and can be incorrect. Most of the wrong information pertains to addresses and phone numbers, but providers could be incorrectly listed as accepting certain health plans.

A good idea is to contact your physicians and ask the office about specific plans. You’ll want to have more information than just the insurer’s name. Physicians may accept one type of health plan from an insurer, but not another. So, give the office the exact health plan name to see whether the physician is in-network for that plan.

What additional benefits do the Medicare Advantage plans offer?

Medicare Advantage plans commonly offer prescription drug, dental and vision coverage.

However, in recent years, they’ve expanded into other areas, such as reimbursing for meal delivery, home safety and rides to doctor appointments. The reason for those expanded benefits is that they can keep people healthy.

According to the Kaiser Family Foundation, in 2022, 98% of Medicare Advantage plans offer telehealth benefits. Some Medicare Advantage insurers are also offering plans with expanded palliative care, adult day health services and caregiver support. During the first year of the COVID-19 pandemic, 49% of Medicare Advantage enrollees used telehealth services, according to the Kaiser Family Foundation.

These benefits aren’t offered in every Medicare Advantage plan. In fact, you may have trouble finding some of this coverage in your area.

Also, additional benefits can come with a higher price tag, so you’ll want to keep that in mind when comparing Medicare Advantage plans.

Is Original Medicare a better choice for you?

According to the Kaiser Family Foundation, most Americans have more than a dozen Medicare Advantage plan options. However, some areas, especially rural locations, have limited or no possibilities. In these cases, you may have no choice but to choose Original Medicare.

Also, you may find that Medicare Advantage plans in your region have limited provider network and your physicians may not even take Medicare Advantage.

Or you may just prefer Original Medicare to Medicare Advantage.

Here’s what you need to know if you’re thinking about going with Original Medicare2:

• Medicare Part A covers hospitalizations. That’s free for nearly all Americans. Part B, which covers physician and outpatient services, costs $164.90 monthly for most people and those with Medicare Advantage plans pay this in addition to any Medicare Advantage plan premiums. There's also a $226 Part B deductible.
• Original Medicare doesn’t include prescription drug coverage. To get that coverage, you need to pair a Part D plan with Original Medical. The average monthly Part D premium varies by plan.
• Original Medicare often has larger provider networks than Medicare Advantage. A more expansive network can make it easier to get care.

No matter whether you choose Original Medicare or a Medicare Advantage plan, make sure to compare plans and find one that makes the most sense to you. With a little effort, you’ll be able to find a plan that meets your specific needs.

Sources:

1. Kaiser Family Foundation. “FAQs on Medicare Coverage of Telehealth.” Accessed August 2022.
2. Medicare.gov. “Costs.” Accessed August 2022.