- Written by Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
- Edited ByMatt Mauney
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.Read More
- Published: August 14, 2020
- Updated: January 17, 2023
- 5 min read time
- This page features 8 Cited Research Articles
- Edited By
How to Compare Medicare Advantage Plans
Most Medicare Advantage plans rely on networks of doctors, hospitals and other health care providers that contract with the insurance company to set fixed prices for services. This helps keep prices low. But going outside the network can be more expensive for you and may not be allowed under certain types of plans.
Understanding how these different types of plans work can help you compare how Medicare Advantage plans fit your wants, needs and finances.
- Health Maintenance Organizations
- HMOs generally require you to use doctors, hospitals and other health care providers within their network with few exceptions. You usually need a referral to see a specialist. Almost all HMOs include prescription drug coverage.
- Preferred Provider Organizations
- PPOs generally allow you to use any doctor or other provider that you want, but you may have to pay more if you go to one that’s not in your PPO network. You do not need a referral to see a specialist. Drug coverage is usually included.
- Sometimes called HMOPOS plans, these are HMO plans that may allow you to receive services from out-of-network doctors, hospitals or other health care providers at a higher cost to you.
- Private Fee-for-Service
- PFFS plans generally allow you to use any doctor, hospital or other provider as long as the provider accepts the plan’s terms. If your PFFS plan does not cover drugs, you can purchase a Medicare Part D drug plan.
- Medicare Medical Savings Account Plans
- Medicare MSA plans deposit money from Medicare into a bank account. You can then use the money to pay for Medicare covered expenses toward your deductible. But the amount deposited in an MSA is usually less than your deductible, so you’ll have to pay for services until your deductible is met.
- Special Needs Plans
- SNPs limit membership to people with specific diseases or conditions. All Special Needs Plans are required to provide prescription drug coverage. You are required to use only doctors, hospitals and other providers in the plan’s network except in emergencies or if you need out-of-area dialysis if you have end-stage renal disease.
Comparing Key Features of Medicare Advantage Plans
Comparing the key features of the different types of Medicare Advantage plans can help you find qualities that are important to you. Generally, you can expect a trade-off between flexibility in your choices of health care providers and overall cost of the Medicare plan.
|Allows you to seek emergency care from outside the network||Yes||Yes||Yes|
|Allows you to seek nonemergency care outside the plan’s network||Yes||Yes, but it may cost you more||Yes|
|Has a network of doctors, hospitals and other health care providers||Yes||Yes||Some plans do, others do not|
|May include prescription drug coverage||Yes||Yes||Yes|
|Requires a referral from your primary care physician to see a specialist||Yes, in most cases||No||No|
|Requires you to have a primary care physician||Yes||No||No|
What to Consider When Comparing Medicare Advantage Plans
Creating a checklist of qualities you want in a Medicare Advantage plan can help you narrow down your choices to a plan that’s right for you.
You’ll need to prioritize your wants and needs in a plan, then see if you can afford the coverage you want. It can also allow you to decide what qualities you are willing to compromise on to save money.
These are the kinds of questions you should ask yourself when comparing and choosing a Medicare Advantage plan.
- Premium Costs
- Consider how much you’re willing to pay each month. And remember, even plans with $0 monthly premiums still require you to pay the Medicare Part B premium of $164.90 per month in 2023, compared to $170.10 in 2022.
- Out-of-Pocket Costs
- Make sure you are comfortable with the plan’s deductible and maximum out-of-pocket (MOOP) costs. In 2022, you could pay a maximum of $7,550 for in-network costs and $11,300 for in-network and out-of-network costs combined.
- Choice of Doctors
- Check to see if your doctor is in the plan’s network. You may have to pay extra for each visit unless you’re willing to change doctors. The same is true for hospitals and other health care providers. Be aware of what seeing providers outside the network will cost you. And consider whether you want to seek a referral to see specialists.
- Prescription Drug Coverage
- Most Medicare Advantage plans include prescription drug coverage. You will still need to see if your current drugs are in the plans formulary. You also want to know what your copayment or coinsurance will be for prescriptions.
- Additional Benefits
- Check to see if the plan offers vision, dental, hearing or other health benefits if these services are important to you.
- Medicare Star Rating
- Medicare provides a five-star rating system ranking every Medicare Advantage plan. The ratings are updated each year, with five stars being the highest score. You can look up a plan’s star rating with Medicare’s Plan Finder tool or by calling 1-800-633-4227. TTY users can call 1-877-486-2048.
8 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, September 27). 2023 Medicare Parts A and B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
- Freed, M. et al. (2022, August 25). Medicare Advantage in 2022: Premiums, Out-of-Pocket Limits, Cost Sharing, Supplemental Benefits, Prior Authorization, and Star Ratings. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-premiums-out-of-pocket-limits-cost-sharing-supplemental-benefits-prior-authorization-and-star-ratings/
- Freed, M., et al. (2021, November 2). Medicare Advantage 2022 Spotlight: First Look. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look/
- U.S. Centers for Medicare & Medicaid Services. (2020, April 8). Final Contract Year 2021 Part C Benefits Review and Evaluation. Retrieved from https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/final%20cy%202021%20part%20c%20bid%20review%20memorandum_4-8-2020_7.pdf
- U.S. Centers for Medicare & Medicaid Services. (2019, September). Understanding Medicare Advantage Plans. Retrieved from https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How do Medicare Advantage Plans Work? Retrieved from https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Advantage Plans. Retrieved from https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Advantage Plans Cover All Medicare Services. Retrieved from https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services
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