Medicare Advantage plans are growing in popularity, even winning over some of their skeptics. Whether you are close to entering Medicare, or if you’ve been in the program for many years, you may be wondering, What is the top Medicare Advantage plan? In this short guide, we’ll discuss some ways to determine which Medicare Advantage plan is best able to meet your unique needs.
Basics Of Medicare Advantage
For starters, we’ll review some of the basics of the Medicare Advantage program. These plans, which are also called Part C plans (because they are known as Part C of Medicare), are an alternative to Original Medicare. You can think of Part C plans as a way to receive your benefits under Original Medicare through a private insurance company. It is important to understand that everything that is covered by Original Medicare (Parts A and B) is covered by Medicare Advantage. So, Medicare Advantage plans are in no way a downgrade from Original Medicare in terms of covered services or costs. In fact, Part C plans have a similar cost structure to Original Medicare, especially for Part B services and procedures.
Important Ways To Compare Medicare Advantage Plans
When looking for the top Medicare Advantage plan, it’s important to start with the right context. First of all, Medicare Advantage plans are designed to work in certain “service areas.” This is the area that the plan is available for enrollment in. In other words, you can’t enroll in any Medicare Advantage plan anywhere in the country. Instead, you have to choose from those available in your area.
Now you can start to see that there isn’t going to be one top Medicare Advantage plan for everyone. Instead, you’ll want to look for the top plan in your area. To help you do that, you’ll want to compare plans on these metrics:
- Monthly premium
- Annual deductible
- Annual Out of Pocket Maximum (OOPM) amount
- Cost structure (costs for services and procedures that are important to you)
- Extra Benefits
Let’s review each of these areas before moving on the Number One most important criteria for choosing a Medicare Advantage plan.
Many plans actually have zero monthly premiums. Others do have a premium. While you’ll want to compare plans based on all of the criteria in this guide, lower premiums are generally preferred.
Once again, many plans don’t have a deductible. If you don’t have a zero deductible plan available, you’ll want to find a plan with the lowest possible amount.
Annual Out Of Pocket Maximum (OOPM) Amount
This is a very important criterion. The amount represents the most that you’d spend on medical care during one calendar year. The OOPM feature is one of the biggest benefits of Medicare Advantage over Original Medicare. Under Original Medicare, your costs are not limited, but they are with Medicare Advantage. Once again, you probably want the plan with the lower out of pocket maximum amount.
Cost structure refers to the specific co-payments and co-insurance you’ll have to pay for services and procedures under the terms of a Medicare Advantage plan. You can look at these numbers in one of two ways:
- Costs for services and procedures that you’re likely to use frequently
- Costs for rare but more expensive services and procedures
If you want to have the best plan for common or frequent services you’ll want to compare plans based on the costs for seeing your Primary Care Physician or Specialists. You might also want to look at the cost for lab work and diagnostic imaging.
On the other hand, if you’re concerned about infrequent but high cost expenses, look at the daily inpatient hospitalization co-payments. You’ll also want to look at the cost for outpatient surgeries and durable medical equipment. These are examples of services and procedures that can accrue significant cost.
The term Extra Benefits refers to those items that are covered by a Medicare Advantage plan, but not covered by Original Medicare. Remember, Medicare Advantage plans must cover everything that Original Medicare covers; however, they are allowed to cover more than this if they want to. Most Part C plans do offer some Extra Benefits. The most common include:
- Vision, hearing, and dental coverage
- Gym memberships or other health programs
- Home safety monitoring programs
- Over the counter benefits (credits towards the cost of certain OTC items)
Plans are not required to offer all of these, but since they frequently do, you can compare plans based on the value of these benefits. If you wear eyeglasses or contact lenses, you might prefer to choose a Medicare Advantage plan with a richer vision benefit. The same concept applies if you wear hearing aids.
A major form of Extra Benefit is prescription drug coverage. Many Medicare Advantage plans come with drug coverage built-in. Unless you have drug coverage from the VA or Tricare, you’ll probably need to choose a plan that has drug coverage if you want a Medicare Advantage plan. This brings us to the last category for determining the top Medicare Advantage plan, and it’s also the most important: Plan Drug Formularies and provider networks.
Drug Formularies And Provider Networks
It is crucial to understand that every Medicare Advantage plan has a different mixture of the drugs it covers (plans are not required to cover every medication available) and the providers who accept the plan. When you investigate Medicare Advantage plans, you always want to make sure that they are accepted by the medical providers that are important to you and that they cover the medications that you take. Don’t get caught up in all the other criteria like plan costs and extra benefits if your doctors don’t accept the plan and your medications aren’t covered. This is an exercise in frustration.
Instead, focus on plans that work with your providers and medication needs. Once you’ve found two or more plans that meet these basic needs, you can move on to other comparisons like extra benefits and plan cost structure. When you want to know, What is the top Medicare Advantage plan, use this method to make sure you find the one that’s tops for your specific needs.
Work With A Professional To Find Your Plan
There are a lot of moving parts when it comes to finding a Medicare Advantage plan that’s a good fit. A great way to find your optimal plan is to work with a licensed insurance agent. A licensed health insurance agent can help you look up your providers and medications to make sure your plan will meet your needs. They can also help you compare costs across plans. You can start working with an independent professional today; simply contact us to get started with a free consultation.