How to find the right Medicare Advantage plan for you

People who qualify for Medicare, the government insurance program that covers more than 50 million older adults, have two coverage options, according to the Kaiser Family Foundation.

You can choose between:

• Original Medicare, which is offered by the federal government and includes hospital and medical insurance.
• Medicare Advantage, which is provided through a private insurer and includes both hospital and medical insurance, as well as likely offering prescription drug and supplemental benefits.

Original Medicare has been around since 1965 and includes Parts A and B. It doesn’t have prescription drug benefits, but you can get a separate Part D prescription drug plan.

Medicare Advantage, also called Part C, hasn’t been around nearly as long. About one-third of Medicare beneficiaries have Part C, and that fraction is expected to grow in the coming years as more private insurers offer plans.

The most common type of Medicare Advantage plans are health maintenance organization (HMO) plans, though insurers also offer other types of plans like preferred provider organization (PPO) plans.

Most Americans have more than a dozen Medicare Advantage plan choices. To help people compare plans, the Centers for Medicare and Medicaid Services (CMS) issues star ratings each year to measure each plan’s quality. The top plans get five stars.

When looking for a Medicare Advantage plan, a good idea to start is looking at five-star plans. Here's what you need to know about five-star Medicare Advantage plans, a breakdown of the top plans and key things to consider before choosing one.

What are five-star Medicare Advantage plans?

A five-star rating indicates a high-quality, high-performance plan. Medicare rates plans from one to five stars based on several factors.

The agency uses information from healthcare providers, member satisfaction surveys and the health plans themselves to determine the ratings. Medicare rates Medicare Advantage plans on up to 45 different quality and performance measures, including:

• Breast cancer screening
• Colorectal cancer screening
• Diabetes care
• Older adult care
• Care coordination
• Customer service
• Health plan complaints
• Members choosing to leave the plan
• Promptness of appointments and care
• Claims appeal process speed

According to CMS, “approximately 68 percent of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2022, up from 49 percent in 2021.”

About 90% of Medicare Advantage plan members with prescription drug coverage are in a plan with at least four stars.

Five-star rated Medicare Advantage plans

Here's an overview of the five-star Medicare Advantage plans for 2022.

What to think about when choosing a Medicare Advantage plan

While Medicare's rating system can steer you toward plans that rank highly on several quality and performance measures, it's still important to do your own research and find a plan that aligns best with your particular needs.

When comparing plans, pay close attention to what healthcare providers and hospitals are in the network. If you already receive care from a specific provider, double-check to make sure he or she is considered in-network under the plan. Also, call your doctor's office to make sure the provider accepts the plan before enrolling. Some providers may not accept specific Medicare Advantage plans.

Doing this extra legwork is important. Otherwise, you may incur extra costs for going out-of-network or have to switch to another provider who is within the plan's network or accepts this insurance.

Also, look at the:

• Monthly premiums, which is what you pay for the coverage.
• Deductibles, which is what you pay for health care services before the plan kicks in money.
• Coinsurance, which is your portion of the health care services costs after you reach your deductible.

Some plans may offer a lower monthly premium in exchange for a higher deductible and coinsurance. Some plans may have a high out-of-pocket maximum, which is the most you'll pay for covered services each year.

Medicare has set the out-of-pocket cost limit at $7,550 for Medicare Advantage plans. However, some plans may have a lower out-of-pocket maximum, while some may be right at this threshold. You’ll want to weigh all of these costs and figure out whether you’d prefer to pay higher premiums or out-of-pocket costs.

Plan benefits are another critical factor. Look at whether the plan offers supplemental benefits, such as vision or dental coverage. If you take several prescription medications, see if the plan provides prescription drug coverage and what medications are listed in its formulary and covered by the insurer. If your medications aren't covered, shop around for another plan that better meets your needs.

Whether you've just become eligible for Medicare or are switching plans during a special enrollment period, you can use Medicare's Plan Finder tool to find Medicare Advantage plans offered in your area. Start there, but if you have additional questions or are unclear about potential costs or what is covered and what isn't, don't hesitate to call the insurer, talk to a representative and get clarification before you make a final decision.

Source:

• CMS. 2022 Star Ratings Fact Sheet, Accessed August 2022.

Disclaimer:
Insurance.com is not affiliated with or endorsed by the government or Federal Medicare program. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week, to get information on all of your options. Not all plans offer all of these benefits. Benefits and availability may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system. Part B Premium give-back is not available with all plans. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

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