Compare 2023 Medicare Advantage Plans by State

When it comes to healthcare, the significance of Medicare Advantage (or Medicare Part C) is undeniable. This is one of the well-recognized health insurance plans in the US that is offered to individuals age 65 or above. In 2023, a total of 3,834 various Medicare Advantage Plans were provided by different insurance providers nationwide. Thus, choosing the best Medicare Advantage Plan personalized to your health condition can be complicated. Besides, if you are entering the 18.4% of the US populace enrolled in Medicare, you may find it overwhelming which exact coverage to choose from.

If you are looking for the best Medicare Advantage Plan for yourself or the elderly in your home, you might be wondering which Medicare Plan you should choose as there are a plethora of plans making it a challenging task. Here, you must note that choosing the right Medicare Advantage depends on your specific medical needs, personal situation, affordability, travel coverage, and other factors. MedicareHelp will help explore things to consider while choosing the best Medicare Advantage plan.

What is a Medicare Part-C Plan?

Since 1965, Medicare has been contributing to people's health by providing adults (age 65 or above) with medical relief through Medicare Plans. Medicare falls under the CMS mandate (Center for Medicare and Medicaid Services), a federally regulated program applicable across the country.

To thoroughly understand the Medicare Advantage Plan (Part C), you must understand the Original Medicare Plan. The latter consists of 2 parts (Part A and Part B).

• Part A of Original Medicare (Hospital Insurance) is a fee-for-service health plan for Medicare recipients. This healthcare plan covers all costs related to the hospital stay, including home care, nursing care, and hospice care.

• Part B (Medical Insurance) covers outpatient and preventive services. This plan also covers all the costs related to doctor visits and lab work.

Note: you will have to pay for premiums towards any plan.

On the other hand, Medicare Advantage Plan (MA Plan or Part C) is offered by private companies approved by Medicare. Most importantly, this MA Plan provides all benefits of Part A and Part B, excluding hospice services and other clinical trials (research studies). This plan also excludes any new benefit determined by the national coverage or legislation. Interestingly, Medicare Advantage Plan also offers some additional benefits, including dental, hearing, and vision coverage.

Now let’s have a look at the different types of Medicare Advantage Plans to better understand which plan best suits your healthcare needs.

How to Choose the Best Medicare Advantage Plan

Compare Medicare Advantage Drug Prices

First things first, you need to determine your budget when choosing the best healthcare plan. You must consider the cost of the plan and select the one that fits your needs and budget.

• Evaluate your deductibles, premiums, and other related costs.

• Consider how much you need to pay for healthcare services, such as doctor visits and hospital stays.

• Consider the yearly limit of your out-of-pocket medical services.

• Carefully review the coverage rules to understand any rule that may affect your budget.

With Medicare Advantage Plans, there is a yearly limit on out-of-pocket medical services. Thus, once the yearly limit is reached, you will not be required to pay for the covered medical services for the whole year, making this plan a cost-effective option for you. You can use this tool to find the best healthcare and drug plan.

• Reflect on Your Coverage Priorities

Another thing that you must consider is to check whether the plan you are applying for covers the medical services you need. Generally speaking, almost all Medicare Advantage plans offer the benefits of Original Medicare (Hospital and Medical Coverage).

While choosing the Medicare Advantage Plan, make sure you consider the coverage type you need in addition to the coverage provided by the Original Medicare. This is because many MA plans offer only one of the following coverages if not all.

Following are the types of medical coverages offered by the Medicare Advantage Plan:

• Medical Transportation

• Vision Coverage (inclusive of yearly procedures and examinations)

• Hearing Coverage (inclusive of yearly procedures and examinations)

• Dental Services (inclusive of yearly procedures and examinations)

• Fitness Services (gym memberships or discounts on fitness programs)

• Prescription Drug Coverage

• Other additional healthcare benefits

In order to find the best Medicare Advantage Plan, you must check the services you need to receive from the plan by evaluating what it covers. Once you have found the coverage checklist suitable to your needs, you may compare the plans and their coverages using the find a plan tool on Medicare’s site.

• Travel Coverage

Generally, Original Medicare does not cover healthcare outside the US. However, you can buy the Supplement Insurance (Medigap) policy that will cover all your emergency care when traveling outside the country. Similarly, in most cases, Medicare Advantage Plans don’t pay for medical supplies outside the 50 states of the US. However, you can have travel coverage outside the country by buying supplemental benefits that offer emergency and urgently needed medical services.

Be mindful that Medicare pays for a specific type of medical care services in a foreign hospital, and that too under 3 situations.

1- When you have an emergency in the US, and the hospital outside is closer, that is capable of treating your injury or illness.

2- If a medical emergency occurs when you are traveling through Canada without unreasonable delay, the Canadian hospital is the nearest one to treat your health condition.

3- In case you live in the US, and the foreign hospital is the only hospital nearest your home that can immediately treat your condition.

• Hospital and Doctor Choice

Another important tip to remember when shopping around for the best Medicare Advantage Plan is to consider whether the doctor or hospital accepts the coverage plans. Besides, you must ensure whether the doctors you are willing to see are accepting new patients or not. Most importantly, you must consider whether or not you are allowed to choose the hospital and care providers of your choice from the Medicare network. Moreover, you should also ensure whether you will need to get referrals.

Speaking of Original Medicare, you can choose any doctor or healthcare provider that accepts Medicare. Similarly, the Medicare Advantage Plans allow medical recipients to choose the healthcare providers who are the participants of the plan’s network. You can find the doctors and pharmacies that are nearest to your home. Here, you must note that many plans also offer out-of-network medical coverage.

• Quality of Care

When enrolling in any healthcare insurance plan, the quality of healthcare you will receive holds immense importance. It is crucial that you must be satisfied with your healthcare. The quality of medical services your healthcare providers offer may vary based on the plan you get enrolled in. It is, therefore, vital for you to evaluate and compare the doctors, hospitals, nursing homes, and medical care providers in your area approved by Medicare.

To get the best plan for your health insurance, get the following information:

• Star and quality ratings for the hospitals, nursing homes, and other healthcare agencies

• Cost estimation of the doctors located in your area

• Hospitals that cater to your specific health conditions (such as dialysis facilities near you)

• Get the contact information for inpatient rehabilitation centers located in your area

• Review Additional Benefits of the Plan

In case you are already enrolled in any specific health insurance plan and receiving various healthcare benefits, you need to choose which Medicare Advantage Plan you’ll get.

For instance, if you are enrolled in the Original Medicare Plan and already receiving the hospital and medical insurance, in addition, if you want to choose the Medigap (Part D), many of your medical needs are already covered.

Nevertheless, you can compare coverages and opt for the one that is cost-efficient and better suits your healthcare needs.

Different Types of Medicare Advantage Plans

• PPO (Preferred Provider Organization)

This health insurance plan consists of network doctors, hospitals, specialists, and other healthcare providers. This Medicare Advantage Plan also allows you to use out-of-network healthcare providers for all your covered services (specifically higher-cost services).

• HMO (Health Maintenance Organization)

This plan offers healthcare coverage, particularly from the doctors, hospitals, and other healthcare providers that are included in the network’s plan. However, it excludes out-of-area urgent care, emergency care, or any other temporary out-of-area dialysis). Besides, some HMOs might need a referral from the recipient’s primary care doctor to coordinate with specialist care.

• PFFS (Private Fee-for-Service)

Private health insurance companies offer this Medicare Advantage Plan; however, it differs from the Original Medicare Plan. With PFFS plans, you can receive medical care from any healthcare provider approved by Medicare. These providers accept the permitted fee from your Medicare Advantage Plan.

• MSA (Medical Savings Account)

This plan combines your high-deductible health insurance plans with a medical savings account so that you can pay for your healthcare costs without any burden. If you qualify for the MSA plan, Medicare deposits money into the recipient’s account that they can use for their healthcare costs.

• SNPs (Special Needs Plans)

This Medicare Advantage Plan offers extra benefits and healthcare services to individuals with specific health conditions and medical needs. Special Needs Plan also includes Part D (Coverage of prescription drugs). Under SNPs, the recipient gets the coverage of hospital stays, doctor’s visits, medications, and other medical services people may need to manage their health. To qualify for this plan, you must prove your level of income and medical diagnosis of your chronic health condition.

• HMO-POS (Health Maintenance Organization-Point of Service Plans)

This type of plan typically has healthcare provider networks; however, it also allows medical recipients to use the services outside the plan’s network. Here, you must note that coinsurance and copayment may be relatively higher as you opt for out-of-network medical services. Make sure you follow all the set rules of the plan, such as getting prior approval for specific healthcare services when the Medicare Advantage Plan needs it.

The Takeaway

All in all, if you want to get all the benefits of Medicare coverage in one package, choose the Medicare Advantage Plan. This plan provides you with all the coverage benefits of Original Medicare along with additional benefits like vision and dental coverage and gym membership.

Besides, when enrolling in any Medicare Advantage Plan, make sure you consider all the factors mentioned above that may affect your plan and services. Most importantly, don’t forget to review the CMS star rating, your healthcare needs and coverage priorities, your budget, choice of doctors, quality of care, and the type of health insurance you are currently having.

Make sure you or your loved ones, who are entering the age of 65, get enrolled in the best Medicare Advantage plan that best fits your medical needs.

Last updated on October 21, 2022