Compare Medicare Advantage Plans
You may have decided you want a Medicare Advantage plan because you like the security of having a plan with an out of pocket maximum or you are seeking extra benefits. The availability of Medicare Advantage plans varies from area to area but you may have five or more to choose from in your zip code. Here’s some things to consider as you compare Medicare Advantage plans.
Compare Medicare Advantage plans costs
Medicare Advantage costs are set by each private insurance company that offers the plan. Three costs to consider include: premiums, copayments/coinsurance, and deductibles. You also should consider the out of pocket maximum as you compare Medicare Advantage plans.
Premiums: this is the amount you pay monthly to have the plan. Some Medicare Advantage plans may have premiums as low as $0.
Copayments/coinsurance: this is the amount you pay whenever you receive care. A visit to a specialist might cost you $35, for example. Picking up a generic prescription drug might cost you $15.
Deductible: this is the amount you pay before your plan begins to pay. A Medicare Advantage plan may have separate medical and prescription drug deductibles.
Out of pocket maximum: All Medicare Advantage plans have out of pocket maximums. This is the maximum amount you pay before your plan pays all covered medical expenses. The amount of the out of pocket maximum can vary from plan to plan. If you predict that you will have a lot of medical expenses, you might want to choose the plan with the lowest out of pocket maximum.
Compare Medicare Advantage plans benefits
Medicare Advantage plans usually offer extra benefits that Original Medical typically doesn’t cover. These benefits could include:
- Routine dental care
- Prescription drug coverage
- Routine vision services including eye exams, contact lenses and eyeglasses
- Routine hearing benefits including routine hearing exams and hearing aids
- Fitness benefits
As you compare Medicare Advantage plans, look at the different copayments for each of these services. For example, one plan may cover hearing aids at $700 twice per year and another may only pay $1,000 every three years. Some plans may only cover hearing aids in the same way as Original Medicare, which is generally not at all.
Compare Medicare Advantage plans types
Most Medicare Advantage plans have networks of preferred providers. Some Medicare Advantage plan types include:
Health Maintenance Organization (HMO)
- An HMO is a type of health-care plan that generally requires you to select a primary care doctor.
- In most cases, you need to get a referral to see a specialist.
- If you don’t follow the plan’s rules for services, you may have to pay the full costs of care.
Preferred Provider Organization (PPO)
- With a PPO plan, you can generally go to any doctor or hospital, but will pay less if you use doctors and hospitals that belong to the plan’s network.
- PPO health plans typically don’t require a referral for care by a specialist. However, if you use out-of-network health care providers or specialists, you may be required to pay a higher portion of the cost for covered services.
Private Fee-For-Service (PFFS)
- With a PFFS plan, you will not need to choose a primary care doctor, and referrals are generally not required for treatment by specialists. However, not all Medicare providers accept the plan.
Special Needs Plans (SNPs)
- Special Needs Plans (SNPs) are available for those who qualify with specialized health needs or who are in other specific situations. For example, you might find a diabetes HMO SNP. These plans tailor benefits and coverage to meet the specific needs and conditions of the people they serve.
Still have questions about comparing Medicare Advantage plans? You can call eHealth to speak with a licensed insurance agent. If you’d like to explore the various Medicare coverage options in your area, use the Browse Plans button on this page.