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 2020, just under 5% of Medicare Advantage plans with prescription drug coverage received a five-star rating. Nearly 11% of Medicare Advantage beneficiaries with prescription drug coverage are in five-star plans. About 18% of Medicare Advantage plans (31% of members) with prescription drug coverage received 4.5 stars and 29% received four stars (39% of members).
The best Medicare Advantage plans
In total, 20 Medicare Advantage plans that offer prescription drug coverage received a five-star rating for 2020.
Some of them fall under the same parent organization, including Kaiser Foundation Health Plan and UnitedHealthcare. Here's an overview of the five-star Medicare Advantage plans for 2020.
Aetna
The type of plans offered: Aetna provides HMO and PPO plans. Consumers have the option to choose between plans that offer both medical and drug coverage or medical-only.
Where Aetna offers plans: 16 counties in Maine for non-employer group health plans (non-EGHP) and most of the U.S. for employer group health plans (EGHP).
Number of members: 8,943
Parent company: CVS Health Corporation
Ratings overview: According to Insure.com's Best Health Insurance Companies ratings, 68% of customers recommend Aetna. Aetna also received high marks for customer service, claims service and its website and mobile app experience. The company additionally received an A for A.M. Best Financial Strength Ratings. That rating means the company is fully capable of meeting its ongoing insurance obligations.
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: 138,591
Parent company: Humana
Ratings 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-.
Florida Blue
The type of plans offered: Florida Blue provides HMO, PPO, regional PPOs (RPPOs) and prescription drug plans.
Where Florida Blue offers plans: 31 Florida counties for non-EGHP and 36 Florida counties for EGHP.
Number of members: 67,907
Parent company: Guidewell Mutual Holding Company
Ratings overview: In Insure’s Best Insurance Companies, 79% of customers recommend Florida Blue and 94% planned to renew. Customers gave the company high ratings for its claims process. Florida Blue also received an A+ rating for its financial strength.
Group Health Plan
The type of plans offered: Group Health Plan offers PPO plans and Medicare Cost plans.
Where Group Health Plan offers plans: Non-EGHP service area includes 21 counties in Minnesota, 14 counties in North Dakota, 11 counties in South Dakota and seven counties in Wisconsin. EGHP service area includes one Wisconsin county.
Number of members: 5,913
Parent company: HealthPartners
Ratings overview: Moody's changed the company's financial outlook to negative in early 2020. However, in 2019, the National Committee for Quality Assurance rated HealthPartners as one of the top commercial plans in Minnesota.
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 17 Florida counties, while EGHP service area encompasses 50 Florida counties.
Number of members: 48,112
Parent company: Cigna
Ratings 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: 48,646
Parent company: Anthem
Ratings 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: 34,967
Parent company: Kelsey-Seybold Medical Group
Ratings overview: The plan received five stars last year, 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, Georgia, Washington, California, Hawaii 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
Ratings overview: Kaiser had seven plans with five-star ratings, three of which received the same rating last year. 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: 1,725
Parent company: Martin's Point Health Care
Ratings overview: The plan received a 4.5-rating last year.
Medical Associates Health Plans
The type of plans offered: Medical Associates Health Plans offers Medicare Cost plan.
Where Medical Associates Health Plans offer plans: Non-EGHP service area includes 68 counties in Iowa, 49 counties in Nebraska and two counties in Illinois.
Number of members: 12,573
Parent company: Medical Associates Clinic
Ratings overview: Medical Associates is the sole MA-only plan (no prescription drug benefits) to receive a five-star rating, a distinction it also received last year.
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, one Illinois county and 14 Wisconsin counties.
Number of members: 16,772
Parent company: University of Wisconsin Hospitals and Clinics Authority
Ratings overview: The University of Wisconsin Hospitals and Clinics Authority received a stable financial rating from Moody's in late 2018. In 2018 & 2019, it received an overall 4.5 star rating from Medicare.
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: 102,203
Parent company: Tufts Health Plan
Ratings overview: Tufts has received a five-star rating from Medicare every year between 2016-2020. 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. The plan received the same high rating for 2019-2020.
UnitedHealthcare
The type of plans offered: UnitedHealthcare offers HMO and PPO plans.
Where UnitedHealthcare offers plans: The non-EGHP service area for UnitedHealthcare Benefits of Texas includes 53 Texas counties. United's Care Improvement Plus South Central Insurance plan covers an EGHP service area that includes most of the U.S. and a non-EGHP service area that includes one New York county.
Number of members: More than 258,000 members.
Parent company: UnitedHealthcare
Ratings overview: UnitedHealthcare Benefits of Texas received a five-star rating last year. Parent company 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 2020, Medicare has set the out-of-pocket cost limit at $6,700 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.
