How to Choose the Best Medicare Advantage Plan

You've got a lot of choices when it comes to your Medicare coverage. If you've already made the choice to enroll in Medicare Advantage, now you've got to decide which specific Medicare Advantage plan is right for you. To do that, you'll need to understand the differences between the types of Medicare Advantage plans available.

First of all, please understand that there is no "best Medicare Advantage Plan".  There is only the plan that works for you.  The plan that may work for you, might not work that well for your next-door neighbor or best friend.

Types of Medicare Advantage Plans

There are a total of five different kinds of Medicare Advantage plans. We'll talk about them briefly so that you know what the major differences are.

Health Maintenance Organizations (HMO)

HMOs are one of the more common types of Medicare Advantage plans. They require their members to receive care from a provider and facility that participate in their network. If a member receives care outside of the network, the plan does not help with any of the expenses, and the member must pay 100% out-of-pocket. These plans also require their members to choose a primary care physician and get a referral if they need to see a specialist.

Preferred Provider Organizations (PPO)

PPOs are the other most common Medicare Advantage plan type. They work similarly to HMOs but usually have a wider network of providers, which gives their members more freedom to choose providers. While they do prefer their members to see a provider who is in the PPO network, they do offer benefits outside of the network. Out-of-network benefits are usually lower, and the member will pay more for healthcare outside of the network.

PPO plans do not generally require their members to designate a primary care physician or obtain a referral for specialist visits.

Special Needs Plans (SNP)

SNPs are only available to those with certain conditions. They are tailored to conditions so that their members receive the care they need to have the best possible outcome. SNPs are common for individuals with cancer, dementia, End-Stage Renal Disease, and other conditions. They are also available for individuals who live in institutions and people who are eligible for both Medicare and Medicaid.

Private Fee-for-Service Plans (PFFS)

PFFS plans do not have a network of providers. Individuals on these plans can choose to see any provider who has accepted the plan's payment terms and conditions. Providers can choose to discontinue this acceptance at any time, leaving members the burden of verifying acceptance before every visit.

Medical Savings Accounts (MSA)

MSA accounts are quite different than the other types of Medicare Advantage plans. These plans have a high deductible that members must meet before any of their healthcare needs are covered. However, these plans also come with a special savings account into which a certain amount is deposited each year. Members can use this amount to help pay for the deductible or for any other qualified medical expenses.

Considerations When Choosing a Medicare Advantage Plan

Now you have a high-level overview of what each kind of plan offers. Limitations and requirements can vary between the types of plans since they can be offered by a number of private insurance companies. There are a few questions you should ask yourself when choosing which Medicare Advantage plan is right for you.

First, are your current providers part of the network? If you are considering an HMO plan, are your current providers part of that plan? If they are not, are you willing to change providers? It's also important to keep in mind that your providers can choose to discontinue their relationship with the plan. They may be part of the network one year and not the next.

Second, does the plan you're considering have prescription drug coverage? Many Medicare Advantage plans include prescription drug coverage in their benefits, but it is still important to verify. Not only that, but you will need to find out if your current medications are included in that drug coverage.

Third, what is the maximum out-of-pocket expense dictated by the plan? If you see a doctor frequently, costs can quickly add up in a Medicare Advantage plan. You will always have a copay for visits, so depending on how often you see a doctor, those copays could quickly amount to several hundred dollars. Fortunately, Medicare Advantage plans have a cap on how much their members must pay. After that amount, your expenses will be covered at 100%.

Lastly, what other benefits does the plan offer? Will you have coverage for dental, vision, and hearing services? Maybe a gym membership? Find out which benefits are important to you and look for a plan that includes them.

This does not cover everything you should know or consider when choosing a Medicare Advantage plan, but it is a good start. This process can be time-consuming and often confusing. Working with a licensed agent is a great way to make sure you enroll in the best Medicare Advantage plan

Find a local agent by searching this site at https://certifiedmedicareagents.com/  Our listed agents and brokers can show you a side-by-side comparison and help you sort through which benefits are important to your personal situation, and which are just "noise".