Medicare Advantage is similar to the employer-sponsored health insurance plan you may have had in the past. You choose a company and a plan that fits your needs. In exchange for a monthly premium, the insurance company pays a portion of covered health care costs. Many of these plans cover other services you’re used to, such as dental, vision, and prescription drug coverage.
Like other insurance plans you may have had, choosing the right plan for your needs is critical. Merely shopping for the lowest premium could cost you more out of pocket later. Since every Medicare recipient’s requirements vary, there’s no single “best” Medicare Advantage plan. Instead, we’ll give you a list of things to consider when choosing the right plan for you.
To learn more about how Medicare Advantage fits into the overall Medicare landscape, check out our Medicare Guide.
How to choose the best Medicare Advantage plan
- Understand the types of Medicare Advantage plans.
- Consider your current coverage needs, such as prescription drugs and whether you want to keep your current doctor.
- Compare plans available in your area.
Five things to consider when choosing a Medicare Advantage plan
The best Medicare Advantage plan is the one that best fits your unique needs, so ask yourself some questions about what you want in a plan.
1. What type of Medicare Advantage plan do you want?
Before choosing a Medicare Advantage plan, it may be helpful to understand your options. Medicare Advantage plans come in several types, including these:
- Health Maintenance Organization (HMO): Beneficiaries must stay within a network of providers.
- Preferred Provider Organization (PPO): Members can receive out-of-network care but will pay a higher cost.
- Private Fee-for-Service (PFFS): You likely won’t have access to a network and will need to check with each provider to see if they will accept your plan for the specific service you’ll receive.
- HMO Point-of-Service (HMO-POS): This option is like an HMO, but includes the option to go out of network at a higher cost with any provider that accepts Medicare.
If you haven’t had employer-sponsored health care before or if you’ve had an Original Medicare plan for a while, you might not be familiar with these types of plans. Check out our Medicare Advantage plans guide to learn more about these and other types of plans.
Once you understand coverage types, start thinking about your coverage needs.
2. Do you take any prescription drugs?
Many Medicare Advantage plans include Medicare prescription drug coverage, but what medications are covered and how much they cost varies. Make a list of your medications and reference it while comparing plans.
If you don’t take any prescriptions now, it may still be worth considering plans that include drug coverage. If you go without any drug coverage and you later require medication, you could end up covering prescription costs yourself or paying a Part D late enrollment penalty.
3. Do you want to keep your current doctor?
Some people develop close relationships with their primary care physician (PCP) or specialists, but many Medicare Advantage plans require that you see doctors within the plan’s network. Other plans may not have a network of preferred providers, and some will allow you to see out-of-network providers at a higher cost.
If keeping your doctor is essential to you, ask your doctor’s office for a list of either Medicare plans that are accepted there or insurers they accept. Alternatively, choose a plan that doesn’t restrict you to a network.
4. How often do you need health care services?
As is typical of many kinds of insurance, low premiums don’t mean low overall costs. Often, a small premium means higher copayments, coinsurance, and deductibles. So when choosing a Medicare Advantage plan, it helps to think about how much you expect to use your Medicare benefits.
If you think you’ll use your health insurance often, it could make sense to pay a higher monthly premium to have lower out-of-pocket costs. If you rarely see the doctor, however, you might save more if you choose a low premium plan, even if its other costs are higher.
To get an idea of what your health benefits could cost you, learn more about Medicare premiums and deductibles.
5. What benefits matter most to you?
While Original Medicare doesn’t cover benefits such as dental and vision, many Medicare Advantage plans do.
The following is a list of services you may want to look for when comparing Medicare Advantage plans. Make a list of the benefits on the following list—and others—that you want your Medicare Advantage plan to cover.
- Eye exams and regular vision care
- Hearing aids
- Preventative dental care
- Fitness memberships and other wellness benefits, such as the SilverSneakers program
- Alternative therapies, such as chiropractic, acupuncture, and naturopathy
Next steps: compare Medicare Advantage plans
Once you’ve considered your health care needs, you can start comparing Medicare Advantage plans. You’ll be glad to know that the Centers for Medicare and Medicaid Services (CMS) assign ratings to all Medicare Advantage (and Part D) plans based on quality and performance. A Medicare Star Rating of 3 out of 5 is considered average.1
If you’re looking for information to help you compare specific plans and companies, check out our Medicare insurance reviews. Or a licensed sales agents can search for plans in your area to help you find the best Medicare Advantage plan for you.
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What is the top-rated Medicare Advantage plan?
The highest possible Medicare Star Rating is five stars, and several companies offer five-star plans.2 These high-rated plans are unique because, if there’s one available near you, you don’t have to wait until the Medicare Open Enrollment to apply. You can join a five-star plan that serves your area any time, as long as it’s taking new members.
Which is best: Medicare Advantage or Medigap?
Medicare Advantage and Medicare Supplement (Medigap) plans are two different things—and each is appealing in its own way. Medicare Advantage plans often cover services Original Medicare doesn’t, such as dental and vision care. Medicare Supplement plans generally don’t cover more services, but their purpose is to help pay for the costs of Original Medicare, such as copayments and deductibles.
Which type of plan is right for you depends on your circumstances, and may depend on your Medicare eligibility.
Disclaimer: Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively “Medicare System Providers”). Eligibility.com is a DBA of Clear Link Technologies LLC and is not affiliated with any Medicare System Providers.