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How Do I Pick the Best Medicare Advantage Plan for Me?

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Are you looking for a Medicare Advantage plan? The Centers for Medicare & Medicaid Services reported that 21,327,223 people were enrolled in Medicare health plans such as Medicare Advantage nationwide, as of July 2018. That’s more than a third of all Medicare beneficiaries. It’s a good idea to go into your search well-informed so you can choose the best Medicare Advantage plan for you.

What types of Medicare Advantage plans are there?

Medicare Advantage plans are available from private insurance companies that contract with Medicare to give you your Medicare Part A and Part B benefits. Some Medicare Advantage plans offer benefits beyond the Part A and Part B benefits, such as routine dental care or even acupuncture.

So before you decide which Medicare Advantage plan is best for you, you might want to learn about the different types of these plans.

Medicare Advantage Health Maintenance Organization (HMO) plans generally limit you to health-care providers within the plan’s network. These plans may often have lower premiums than other types of Medicare Advantage plans. You typically need to select a primary care physician for referrals and to help coordinate your care.

Medicare Advantage Preferred Provider Organization (PPO)* plans generally have provider networks, but let you get care from out-of-network doctors – often with a higher coinsurance or copayment. You usually don’t have to select a primary care physician, and you generally don’t need referrals to see specialists.

Medicare Advantage Health Maintenance Organization-Point of Service (HMOPOS) plans generally have provider networks, but let you get services outside the network. There may be a higher copayment or coinsurance when you go out-of-network.

Medicare Advantage Special Needs Plans (SNPs) are designed around certain health conditions, such as chronic heart failure or diabetes mellitus. In most cases, you need to:

  • Use providers in the plan’s network
  • Select a primary care provider
  • Get a referral to see some (not all) types of specialists

SNPs include prescription drug coverage. You need to meet certain criteria to qualify for an SNP. If you have a health condition, you might want to call Medicare to see if you’re eligible for an SNP. You can reach a representative 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Medicare Advantage Private Fee-for-Service (PFFS)** plans generally set their own payment terms with health-care providers. You might have your choice of which doctor to see, as long as your doctor accepts Medicare assignment and the PFFS plan’s payment terms. Some PFFS plans have provider networks. You usually don’t have to select a primary care physician, and you generally don’t need referrals to see specialists.

How can I decide the best Medicare Advantage plan for me?

Trying to decide which is the best Medicare Advantage plan for you? It may help to go through the questions below. And remember, it’s not only the type of Medicare Advantage plan that matters. You may also want to compare plan costs and other details to find the plan that may suit your needs.

  • Do you take medications? Most Medicare Advantage plans include prescription drug coverage, but not all plans do. If you take medications, make sure the plans you’re considering include prescription drug coverage – and your medications specifically. You can click Browse Plans on this page, which displays Medicare Advantage plans in your area, and then enter your “Rx drugs” to see if the plan may cover them.
  • Do you have favorite doctors and specialists? Check to see if the plans you’re considering require you to use a provider network. If so, see if your doctors are in that network. You can either ask your doctor or contact the plan.
  • Is saving money important to you? Some Medicare Advantage plans have premiums as low as $0, but don’t forget to look at the other plan costs, too. Compare annual deductible amounts and coinsurance/copayments for similar services.
  • Are certain “extra benefits” important to you? Some Medicare Advantage plans include extra benefits, like routine vision, hearing, or dental care. Some even include membership in fitness programs.

How can I compare plans to find the best Medicare Advantage plan for me?

Here’s an easy, quick way you can compare Medicare Advantage plans with no obligation. Just enter your ZIP code in the box on this page and click Browse Plans anytime you’d like.

You’ll see a list of plans in your area, with details about each (such as the monthly premium). You can enter your doctor’s name and prescription medications. If you see a plan that seems like the best Medicare Advantage plan for you, you can click Enroll to apply for the plan.

Once you find the best Medicare Advantage plan for you, know when to sign up

Here are a couple of quick things to know about Medicare Advantage plans.

  • You need to be enrolled in Medicare Part A and Part B.
  • You must live within the plan’s service area.
  • You continue paying your Part B monthly premium, along with the plan premium (if it charges one).
  • You have limited windows of time to sign up. Learn about the Medicare Advantage enrollment periods.

Would you like to learn more about Medicare Advantage plans? You can get personalized assistance from a licensed eHealth insurance agent by contacting us today.

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

**A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with the plan are not required to see you except in an emergency.

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