What are the Best Medicare Advantage Plans?

By James O'Neal

Are you stumped by Medicare?

Deciding which plans are the best Medicare Advantage Plans can be daunting.

Did you know that the number of beneficiaries enrolled in Medicare private plans tripled since 2004? (13% in 2004 || 33% in 2017) So how does that affect you?

More interest means more available plans. The benefit is you have more options to choose from. The drawback is, with so many options, choosing is more difficult.

So where do you start?

You must first understand what types of plans exist. Then you can narrow the scope of your search. You’ll include only plans relevant to your state and particular situation.

Look at the facts below to get started.

By the time you finish this article, you’ll know:

  • What types of plans exist
  • What to include on your checklist
  • What steps to take next to find the best Medicare Advantage Plans

Health Maintenance Organization (HMO) Plan

HMO plans cover care given by hospitals, doctors, and other healthcare providers in your plan’s network. They need you to visit your primary care physician to receive a referral.

Only then will they cover the costs of specialists. They also need prior approval for most costly services.

Who Provides the Actual Care?

Hospitals, doctors, and other healthcare providers in your plan’s network provide the care. There are a few exceptions:

  • Emergency Care
  • Out-of-Area Dialysis
  • Out-of-Area Urgent Care

Other exceptions include point-of-service (POS) options offered by select HMOs. Each HMO provides different out-of-state services. They change from plan to plan, so keep a sharp eye out.

Prescriptions Drug Coverage

HMO plans cover the cost of prescription drugs. If you need “Part D” Medicare drug coverage, double check your plan offers it. Some do, some don’t.

Primary Care Physicians

You need to choose a primary care doctor from the list they’ll provide you.

Specialists

You must have a referral to see a specialist. Few exceptions exist.

Preferred Provider Organization (PPO) Plans

Private insurance companies, such as O’Neal, offer these plans. PPO’s are “Part C” Medicare Advantage Plans. The plans cover costs from any hospital, doctor, or other health care provider you visit. Those within your plan’s network cost far less; those without, far more.

Who Provides the Actual Care?

PPOs cover costs from any hospital, doctor, or healthcare provider. They cover more for those within their network.

Prescription Drug Coverage

Yes, prescription drugs are covered. Select plans offer “Part D” Medicare drug plans. Each plan differs, so you’ll need to research your specific plan.

Primary Care Physicians

PPOs don’t require a primary care doctor. For the same low (or free) cost, you can visit anyone in their network.

Specialists

PPOs require referrals for specialist visits. As usual, if you use those within their network, it’ll cost you far less.

Out of these best Medicare Advantage Plans, which fits your needs better?

Private Fee-for-Service (PFFS) Plans

Private insurance companies offer PFFS. No two plans are alike. Costs for hospitals, doctors, and other healthcare providers change from plan to plan.

Who Provides the Actual Care?

Narrowing down who will give you care typically takes more work with PFFS. Some PFFS plans include a network of providers. Some don’t.

Then it’s up to you to find a hospital, doctor, or health care provider that will accept your plan’s payment terms and agreements. Not all will.

Prescription Drug Coverage

It’s a toss-up. Some do, some don’t. If you choose a plan without drug coverage, you may buy an additional Medicare Prescription Drug Plan. In the long run, it may cost you less.

Primary Care Physician

PFFS don’t require you to choose a primary care doctor.

Specialists

They don’t require referrals for specialists either.

Building Your Checklist

It’s time to build your checklist. Then you can search through the available best Medicare Advantage Plans to find the perfect fit. Get out a handy pen and paper. Write a list which includes the five criteria below. Now, scribble your needs down next to each.

You will use this list when you search for the singular plan which best suits your needs. Steps to accomplish that task are listed at the bottom of this article.

Quality Ratings

Medicare grades health plan quality according to a star rating system. The top rating is five stars. The bottom is one star. Each plan is rated according to factors like quality-of-care and customer satisfaction.

The US government doles out extra money to those plans that achieve at least a 4-star rating.

Participating Hospitals/Doctors

Medicare Advantage plans rely on provider networks. You must use a hospital or doctor in your plan’s network. Only then will Medicare cover the expenses. Their coverage typically covers all, or almost all, the costs.

Deductibles, Co-Pays, and Other Costs

Whenever you look for a plan, pay close attention to costs like doctor visits and hospital stays. Check annual out-of-pocket limits. If the costs are too high, search for similar plans with higher premiums, but lower out-of-pocket limits.

Dental and Vision Coverage

Most advantage plans offer some form of dental and vision coverage. Forewarning, they vary widely. Write down your needs before you search for a plan. This one is easily overlooked.

Travel Coverage

Do you travel regularly? Do you live in another state part of the year? Do you plan on an extended visit with family in another state this year? If you do, be wary. Most plans only cover emergency visits in other states.

Even the simplest costs, such as lab tests, add up quickly. Keep an eye out for plans which include national networks. That way, you can rest assured. You won’t rack up unneeded expenses.

Hunting Through the Best Medicare Advantage Plans

Do you now understand the types of Medicare Advantage Plans available? Have you chosen which best suits your needs? If you answered “no” to either of these questions, be sure to contact a specialist.

If you answered yes to these questions, it’s time to move to the next step.

Grab your filled-out checklist.

Then head over to a site which offers health insurance plan ratings. There, you can check out the best individual plans to suit your needs. Happy hunting.

P.S. Don’t forget to sort the plan ratings by states!