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HEALTH Insurance

Members should compare premiums, costs, provider networks, prescription drug coverage, supplemental benefits, and plans’ quality ratings when selecting a Medicare Advantage plan.

Deciding on a health insurance plan isn’t many people’s idea of fun. However, Medicare has a system that makes it easier to compare plans. 

Medicare Plan Finder lets you shop for Medicare Advantage and Medicare Part D prescription drug plans. The tool is both online and mobile, so you’re able to use a smartphone or tablet to compare plans. 

By logging in and providing information, Medicare Plan Finder helps narrow down your Medicare Advantage plan options. 

The tool provides cost information, both premiums and out-of-pocket estimates. You can enter in your prescriptions and Medicare Plan Finder will provide drug costs, including generic options. 

It also digs into each plan to highlight any supplemental benefits offered. 

Medicare Advantage plans have expanded benefits that go well beyond doctor and hospital visits. Most Medicare Advantage plans have prescription drug benefits and many have vision and dental. In recent years, plans have expanded benefits even more, including plans specifically for people with chronic conditions, such as diabetes. 

You can shop for Medicare Advantage plans when you turn 65. You have three months before and after your 65th birthday to choose a plan. 

After that, you’re able to make changes to your plan either between Oct. 15 and Dec. 7 (Medicare open enrollment) or Jan. 1 to March 31 (Medicare Advantage open enrollment).

Medicare open enrollment allows you to make changes to your Medicare Advantage plans, switch between Original Medicare and Medicare Advantage and vice-versa or choose a Plan D plan. 

Medicare Advantage open enrollment is more limited than Medicare open enrollment. During Medicare Advantage open enrollment, you can only change Medicare Advantage plans or move from a Medicare Advantage plan to Original Medicare. 

The only other time you can make changes to your plan is during a special enrollment period. This period happens if you have a qualifying life event, such as losing health insurance coverage, a spouse’s death, moving to another state or getting your work hours cut. 

Now, let’s look at five questions you should answer when comparing Medicare Advantage plans:

  • Medicare beneficiaries can choose a Medicare Advantage plan during the annual open enrollment, the Medicare Advantage open enrollment, or a special enrollment period, if you qualify.
  • Medicare Plan Finder helps you compare plans, including highlighting each one’s plan ratings that includes member experience, customer service, and quality of care.
  • The average Medicare Advantage monthly premium is $19 for 2022, but many insurers offer zero-premium plans.
  • When choosing a plan, make sure your providers accept that specific Medicare Advantage plan. If your doctor or hospital doesn’t accept that plan, you may have to pay all of the costs when you receive care.

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’ll pay more for health care services in an HDHP. 

The average Medicare Advantage monthly premium is $19 in 2022. That’s on top of Medicare Part B’s monthly premium of $158.50. 

Many insurers 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 supplemental coverage. 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 supplemental 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. 

In 2021, 94% of Medicare Advantage plans offer telehealth benefits. Medicare Advantage insurers are also offering plans with expanded palliative care, adult day health services and caregiver support. 

These supplemental 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? 

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 Medicare: 

  • Original Medicare usually has higher premiums than Medicare Advantage. Medicare Part A covers hospitalizations. That’s free for nearly all Americans. Part B, which covers physician and outpatient services, costs $158.50 monthly for most people. There's also a $217 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 in 2022 is $33 and the deductible is $480. 
  • Original Medicare often has larger provider networks than Medicare Advantage. That 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.