People who qualify for Medicare, the government insurance program that covers more than 44 million seniors, have two coverage options.
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 a and that’s expected to rise 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.
- Seventy-five Medicare Advantage plans with prescription drug benefits received a five-star rating in 2022. That’s an increase from 28 five-star plans in 2021.
- About 90% of Medicare Advantage plan members with prescription drug coverage are enrolled in plans with at least four stars.
- Check out a plan’s Star Rating, premiums, deductibles, coinsurance, out-of-pocket costs, benefits, and supplemental coverage when comparing Medicare Advantage plans.
- Members can use Medicare’s Plan Finder tool to find what plans are available in their area.
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
Seventy-five percent of Medicare Advantage plans with prescription drug benefits received at least four stars for 2022. That's an increase of 28 plans in 2021.
About 90% of Medicare Advantage plan members with prescription drug coverage are in a plan with at least four stars.
The best Medicare Advantage plans
Seventy-five percent of Medicare Advantage plans that offer prescription drug coverage received a five-star rating for 2022.
Here's an overview of the five-star Medicare Advantage plans for 2022.
Contract | Contract name | Parent organization | Number of enrolled | Non-Employer Group Health Plan service area |
---|---|---|---|---|
H0154 | Viva Health, Inc. | Triton Health Systems | 49,828 | Alabama |
H0169 | UnitedHealthcare of the Midwest | UnitedHealth Group | 56,487 | Iowa, Kansas, Missouri, Nebraska |
H0292 | Humana Health Plan of Ohio | Humana | 8,104 | Kentucky |
H0294 | Care Improvement Plus | UnitedHealth Group | 44,651 | Michigan, Wisconsin |
H0332 | KS Plan Administrators | Kelsey-Seybold Medical Group | 39,100 | Texas |
H0524 | Kaiser Foundation Health Plan | Kaiser Foundation Health Plan | 1,295,548 | California |
H0630 | Kaiser Foundation Health Plan of Colorado | Kaiser Foundation Health Plan | 112,250 | Colorado |
H0710 | Sierra Health and Life Insurance Company | UnitedHealth Group | 39,930 | Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Maryland, Maine, Minnesota, Missouri, Mississippi, North Carolina, New Hampshire, New Jersey, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington |
H1019 | CarePlus Health Plans | Humana | 196,637 | Florida |
H1170 | Kaiser Foundation Health Plan of Georgia | Kaiser Foundation Health Plan | 33,989 | Georgia |
H1230 | Kaiser Foundation Health Plan | Kaiser Foundation Health Plan | 34,310 | Hawaii |
H1365 | Martin's Point Generations Advantage | Martin's Point Health Plan | 1,146 | Maine, New Hampshire |
H1537 | Care Improvement Plus | UnitedHealth Group | 2,117 | Alaska, Alabama, Arizona, Arkansas, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Lousiana, Massachusetts, Maryland, Maine, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, North Dakota, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, Wisconsin, West Virginia, Wyoming |
H1951 | Humana Health Benefit Plan of Louisiana | Humana | 185,652 | Louisiana |
H1961 | Peoples Health | UnitedHealth Group | 84,540 | Louisiana |
H1994 | SelectHealth | Intermountain Health Care | 40,095 | Idaho, Nevada, Utah |
H2001 | Sierra Health and Life Insurance Company | UnitedHealth Group | 1,524,329 | Maine, Utah |
H2172 | Kaiser Foundation Health Plan of the Mid-Atlantic States | Kaiser Foundation Health Plan | 101,395 | Maryland, District of Columbia, Virginia |
H2225 | Commonwealth Care Alliance | Commonwealth Care Alliance | 12,058 | Massachusetts |
H2226 | UnitedHealthcare | UnitedHealth Group | 20,168 | Massachusetts |
H2235 | BayCare Select Health Plans | BayCare Select Health Plans | 11,126 | Florida |
H2256 | Tufts Associated Health Maintenance Organization | Point32Health | 104,990 | Massachusetts |
H2292 | Oxford Health Insurance | UnitedHealth Group | 8,638 | New York |
H2416 | PrimeWest Rural MN Health Care Access Initiative | PrimeWest Rural MN Health Care Access Initiative | 1,857 | Minnesota |
H2419 | South Country Health Alliance | South Country Health Alliance | 1,462 | Minnesota |
H2422 | HealthPartners | HealthPartners | 4,876 | Minnesota |
H2425 | Blue Plus | Aware Integrated | 8,388 | Minnesota |
H2459 | UCare Minnesota | UCare Minnesota | 116,476 | Minnesota |
H2462 | Group Health Plan | HealthPartners | 4,157 | Minnesota, Nevada, South Dakota, Wisconsin |
H2610 | Essence Healthcare | Essence Group Holdings Corporation | 63,175 | Illinois, Missouri |
H3344 | Independent Health Benefits Corporation | Independent Health Association | 5,766 | New York |
H3351 | Excellus Health Plan | Lifetime Healthcare | 94,711 | New York |
H3344 | Independent Health Association | Independent Health Association | 59,224 | New York |
H3388 | Capital District Physicians' Health Plan | Capital District Physicians' Health Plan | 42,258 | New York |
H3416 | HealthPartners UnityPoint Health | HealthPartners UnityPoint Health | 3,104 | Iowa, Illinois |
H3557 | Blue Cross & Blue Shield of Rhode Island | Blue Cross & Blue Shield of Rhode Island | 8,140 | Rhode Island |
H3597 | Aetna | CVS Health Corporation | 14,070 | Maine |
H3664 | Aultman Health Foundation | Aultman Health | 15,407 | Ohio |
H3794 | Care Improvement Plus | UnitedHealth Group | 21,493 | Wisconsin |
H3907 | UPMC Health System | UPMC Health System | 154,545 | Ohio, Pennsylvania |
H3916 | Highmark Health | Highmark Health | 161,520 | Pennsylvania |
H3952 | Keystone Health Plan | Independence Health Group, | 82,851 | Pennsylvania |
H3957 | Highmark Choice | Highmark Health | 74,113 | Pennsylvania |
H4152 | Blue Cross & Blue Shield of Rhode Island | Blue Cross & Blue Shield of Rhode Island | 54,115 | Rhode Island |
H4172 | NHC Advantage | Missouri Healthcare Advisors | 925 | Missouri, South Carolina, Tennessee |
H4461 | Cariten Health Plan | Humana | 136,513 | Tennessee |
H4497 | Medical Mutual of Ohio | Medical Mutual of Ohio | 8,241 | Ohio |
H4590 | UnitedHealthcare Benefits of Texas | UnitedHealth Group | 314,930 | Texas |
H4882 | HealthPartners | HealthPartners | 35,878 | Minnesota, Wisconsin |
H5010 | Asuris Northwest Health | Cambia Health Solutions | 913 | Washington |
H5042 | Capital District Physicians' Health Plan | Capital District Physicians' Health Plan | 6,680 | New York |
H5050 | Kaiser Health Plan of Washington | Kaiser Foundation Health Plan | 98,260 | Washington |
H5087 | WellCare of California | Centene Corporation | 69,388 | California |
H5209 | My Choice Wisconsin Health Plan | My Choice Wisconsin | 2,024 | Wisconsin |
H5215 | Network Health | Network Health | 65,611 | Wisconsin |
H5253 | UnitedHealthcare of Wisconsin | UnitedHealth Group | 679,094 | Arizona, Iowa, Illinois, Kentucky, North Carolina, Ohio, Tennessee, Virginia, Wisconsin |
H5262 | Quartz Health Plan Corporation | University of Wisconsin Hospitals and Clincs | 23,024 | Iowa, Illinois, Wisconsin |
H5386 | Sharp Health Plan | Sharp Healthcare | 6,997 | California |
H5410 | Heatlhspring of Florida | Cigna | 61,020 | Florida |
H5420 | Medica Healthcare Plans | UnitedHealth Group | 42,550 | Florida |
H5431 | Healthsun Health Plans | Anthem | 57,295 | Florida |
H5522 | Healthassurance Pennsylvania | CVS Health Corporation | 86,216 | Pennsylvania |
H5526 | Highmark Western and Northeastern New York | Highmark Health | 18,265 | New York |
H5533 | UPMC Health Network | UPMC Health System | 7,875 | Pennsylvania |
H5591 | Martin's Point Generations Advantage | Martin's Point Health Care | 53,423 | Maine, New Hampshire |
H5594 | Optimum Healthcare | Anthem | 52,655 | Florida |
H5652 | Sierra Health and Life Insurance Company | UnitedHealth Group | 5,301 | Colorado, Florida, Kansas, Massachusetts, Maryland, Michigan, North Carolina, New Jersey, Pennsylvania, Texas, Virginia |
H5883 | Blue Care Network of Michigan | Blue Cross Blue Shield of Michigan | 91,548 | Michigan |
H5938 | Capital Health Plan | Guidewell Mutual Holding Corporation | 22,950 | Florida |
H9003 | Kaiser Foundation Heatlh Plan | Kaiser Foundation Health Plan | 101,266 | Oregon, Washington |
H9047 | Providence Health Assurance | Providence Health & Services | 61,891 | Oregon, Washington |
H9096 | Dean Health Plan | SSM Health Care Corporation | 8,467 | Wisconsin |
H9808 | Care N Care Insurance Company of North Carolina | Moses H. Cone Memorial Hospital Corp. | 15,331 | North Carolina |
H9834 | Quartz Health Plan Corporation | University of Wisconsin Hospitals and Clincs | 2,777 | Minnesota |
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.