How to find the best Medicare Advantage plans

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.

What are five-star Medicare Advantage plans?

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

A five-star rating indicates a high-quality, high-performance plan. For 2021, 5% of Medicare Advantage plans with prescription drug coverage received a five-star rating. Nearly half of Medicare Advantage plans with prescription drug benefits received at least four stars. Seventy-seven percent of Medicare Advantage members are in a plan that received at least four stars.

The best Medicare Advantage plans

In total, 28 Medicare Advantage plans that offer prescription drug coverage received a five-star rating for 2021. 

Kaiser Foundation Health Plan has multiple plans that received five stars. Here's an overview of the five-star Medicare Advantage plans for 2021. 

Capital District Physicians’ Health Plan

The type of plans offered: Capital District Physicians’ Health Plan offers HMOs and PPOs.

Where Capital District Physicians’ Health Plan offers plans: Twenty-three counties for non-employer group health plans (non-EGHP) members in New York and 39 counties for employer group health plans (EGHP) members in New York.

Number of members: 5,287

Parent company: Capital District Physicians’ Health Plan, Inc.

Overview: A CDPHP plan received 5 stars from the National Committee for Quality Assurance in 2020 and others received 4.5 stars in 2019 and 2020. 

CarePlus

The type of plans offered: CarePlus offers HMO plans. However, parent company Humana also provides PPO and private fee-for-service plans.

Where CarePlus offer plans: Non-EGHP service area includes 18 Florida counties.

Number of members: 166,821

Parent company: Humana

Overview: The CarePlus plan also received a five-star rating from Medicare last year. Humana received an 83.38 out of 100 overall score on Insure's rankings, ranking highest for its customer service and claims processes. Its A.M. Best financial strength rating is A-.

HealthNow New York

The type of plans offered: HealthNow New York offers HMO and PPO plans. 

Where HealthNow New York offers plans: Eighteen counties in the non-EGHP service area and most of the U.S. in the EGHP service area. 

Number of members: 15,298

Parent company: HealthNow New York, Inc.

Overview: HealthNow New York received an “excellent” rating from the National Committee for Quality Assurance. In 2020, Highmark Health, a Blue Cross and Blue Shield plan, signed an affiliation agreement with HealthNow that will combine the two companies. 

HealthPartners

The type of plans offered: HealthPartners, an integrated nonprofit health system, offers HMO and PPO plans.

Where HealthPartners offers plans: Twelve counties in Minnesota.

Number of members: 4,343

Parent company: HealthPartners, Inc.

Overview: HealthPartners has received five stars the past two years. 

Healthspring of Florida

The type of plans offered: Cigna, Healthspring of Florida’s  parent company, offers HMO, PPO and prescription drug plans in several states. Consumers also have the option to include dental and vision coverage in their health plan.

Where Healthspring of Florida offers plans: Non-EGHP service area includes 20 Florida counties, while EGHP service area encompasses 47 Florida counties.

Number of members: 56,279

Parent company: Cigna

Overview: Cigna received an overall score of 83.95 out of 100 in Insure.com rankings, getting the highest marks for its customer and claims service processes. It also received an A rating for its financial strength. Ninety-three percent of customers said they would renew their policy.

Healthsun

The type of plans offered: Healthsun offers HMO plans.

Where Healthsun offers plans: Non-EGHP service area includes three Florida counties.

Number of members: 52,096

Parent company: Anthem

Overview: In Insure's ratings, 71% of Anthem customers recommended the company, which also received the highest marks for its claims process. The company is financially sound, with an A financial strength rating.

KelseyCare Advantage

The type of plans offered: KelseyCare Advantage offers six different HMO plans depending on location.

Where KelseyCare Advantage offers plans: Non-EGHP service area includes 13 Texas counties. EGHP service area features 242 Texas counties.

Number of members: 38,318

Parent company: Kelsey-Seybold Medical Group

Overview: The plan received five stars the past two years, as well. However, it hasn't yet been rated on its financial strength.

Kaiser Permanente

The type of plans offered: Kaiser Permanente offers a range of HMO and Medicare Cost plans in several states.

Where Kaiser Permanente offers plans: California, Colorado, Hawaii, Georgia, Oregon, Washington and the mid-Atlantic region.

Number of members: About 1.5 million members across these states, with the majority of members -- 1.2 million -- in California.

Parent company: Kaiser Foundation

Overview: Kaiser had six plans with five-star ratings. Seventy-one percent of customers in Insure's rankings would recommend this insurer, which received a nearly 90 out of 100 score for its claims process.

Martin’s Point Generations Advantage

The type of plans offered: Martin's Point Generations Advantage offers HMOs, regional preferred provider organization (RPPO) and local preferred provider organization (LPPO) plans.

Where Martin’s Point Generations Advantage offer plans: Non-EGHP service area includes 16 counties in Maine and 10 counties in New Hampshire.

Number of members: 48,182

Parent company: Martin's Point Health Care

Overview: The plan received the top rating for two straight years. 

Quartz Health Plan

The type of plans offered: Quartz Health Plan offers HMO plans. 

Where Quartz Health Plan offers plans: Non-EGHP service area includes five Iowa counties, five Illinois counties and 27 Wisconsin counties.

Number of members: 18,544

Parent company: University of Wisconsin Hospitals and Clinics Authority

Overview: The University of Wisconsin Hospitals and Clinics Authority received a stable financial rating from Moody's in late 2018. In 2018 and 2019, it received an overall 4.5 star rating from Medicare before getting five stars each of the last two years.

Sierra Health and Life

The type of plans offered: Sierra Health and Life offers HMO and POS plans. 

Where Sierra Health and Life offers plans: Most of the U.S.

Number of members: 44,900

Parent company: UnitedHealth Group

Overview: Sierra Health and Life’s parent company, UnitedHealth Group, received an overall score of 81.10 out of 100 in Insure’s rankings. It ranked highest in claims service process and 91% said they expected to renew. UnitedHealth also got an A rating for financial strength. 

Tufts Associated Health Maintenance Organization

The type of plans offered: Tufts Associated Health Maintenance Organization offers HMOs.

Where Tufts Associated Health Maintenance Organization offers plans: Non-EGHP service area includes 10 Massachusetts counties.

Number of members: 103,907

Parent company: Tufts Health Plan

Overview: Tufts has received a five-star rating from Medicare since 2016. In 2017, the plan also received a five-star rating from the National Committee for Quality Assurance (NCQA) -- a distinction awarded to only three other health plans that year out of the nearly 500 NCQA reviewed. 

UnitedHealthcare

The type of plans offered: UnitedHealthcare offers HMO and PPO plans. 

Where UnitedHealthcare offers plans: UnitedHealthcare’s plan has 10 counties in Massachusetts. 

Number of members: 19,233

Parent company: UnitedHealth Group

Overview: Other UnitedHealth plans received five-star ratings in 2020. For 2021, UnitedHealth’s Massachusetts plan was honored as well as its Sierra Health and Life. UnitedHealthcare received an overall score of 81.10 out of 100 in Insure's rankings, getting the highest grade for its claims service process. Ninety-one percent of customers planned to renew. The company also received an A rating for financial strength.

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. 

For 2021, 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.