Private insurers provide Medicare Advantage Plans as an alternative to Original Medicare. Here’s how to go shopping. You’ve probably heard of Medicare Advantage plans, but do you know how to shop for one (or how they fit into the Medicare world)?
Medicare Advantage plans are a packaged option to Original Medicare, which includes Medicare Part A (hospital coverage), Medicare Part B (medical insurance), and, in many cases, Medicare Part D. (drug coverage). Furthermore, the premiums are set so that you do not require an additional Medigap plan. (In fact, if you have a Medicare Advantage plan, it is illegal for an insurance provider to sell you Medigap coverage.)
Also known as Medicare Part C, Medicare Advantage plans are offered by commercial insurers that Medicare has approved. Most plans provide extra benefits not provided by Original Medicare, such as cost-sharing for dental, hearing, and eye care. In addition, you’ll almost certainly be obliged to use doctors in the plan’s network, but your out-of-pocket payments may be reduced.
Where should you begin?
The Medicare.gov comparison tool is the ideal location to start looking for Medicare Advantage plans (or a Part D or Medigap coverage). After you complete a few questions about your location and any financial assistance you may be receiving — such as Medicaid — the tool will show you all available plans that fulfill your criteria.
» MORE: NerdWallet’s picks for the best Medicare Advantage plans
When comparing plans, you can enter the name, dose, quantity, and frequency of any drug you take regularly — as well as the pharmacy where you get prescriptions filled — if you want to view drug expenses. The final list will then be filled in with your anticipated drug prices for each plan. Plan benefits, plan type, ratings, insurance provider, and drug coverage options can be filtered. Choose up to three plans to compare side by side.
State Health Insurance Assistance Programs can provide real person assistance (called the SHIP network). Although they cannot make individual plan suggestions, they can assist you in selecting a plan. Each state has its SHIP program; discover yours at shiphelp.org.
What are the Medicare Advantage plans available?
Medicare Advantage programs are classified into five types:
- Plans offered by health maintenance organizations or HMOs: Unless it’s an emergency, you must see an in-network physician, and most require a referral to see a specialist.
- Plans with a preferred provider organization, or PPO: Allow you to see both in-network and out-of-network health care providers, albeit going out of network is usually more expensive. PPOs are often networked in a local area, although they may grow larger.
- PFFS (private fee-for-service) plans: Allow you to see any Medicare-approved healthcare provider as long as they accept the plan’s payment terms and agree to see you. You may also have access to a provider network. You can see doctors who do not accept the plan’s payment terms, but you may have to pay more.
- SNPs, or special needs plans: Created to improve care management for Medicare beneficiaries who are dual-eligible for Medicare and Medicaid, require an institutional level of care, or have certain chronic or debilitating diseases such as diabetes, chronic heart failure, or dementia.
- Plans for medical savings accounts, or MSAs: Combine a high-deductible insurance plan with medical savings account for healthcare expenses.
Providers of Medicare Advantage
More information about some of the main Medicare Advantage providers can be found below. These insurers provide coverage in the majority of states. Your ZIP code and county will determine the plans available to you.
- AARP Medicare Advantage plans.
- Aetna Medicare Advantage plans.
- Anthem Medicare Advantage plans.
- Blue Cross Blue Shield Medicare Advantage plans.
- Cigna Medicare Advantage plans.
- Humana Medicare Advantage plans.
- Kaiser Permanente Medicare Advantage plans.
- UnitedHealthcare Medicare Advantage plans.
- Wellcare Medicare Advantage plans.