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Comparing Medicare Advantage Plans

Are you interested in comparing Medicare Advantage plans? Over 30 million people are enrolled in a Medicare Advantage plan, 51 percent of the eligible Medicare population. Here are the five things you should know when you are considering a Medicare Advantage (Part C) plan. Tips from the American Association for Medicare Supplement Insurance.

  1. The average Medicare beneficiary can choose from 43 Medicare Advantage plans.
  2. More plans are available (in 2023) than in any year going back to 2010.
  3. However, some plans have stopped operating.
  4. Free premium does NOT mean you get everything free.
  5. Many plans offer free added benefits like dental and vision. BUT the levels of coverage can vary dramatically.

Why is comparison shopping so important? Say you are a male turning 65 and living in Ohio. You could have as many as 87 different Medicare Advantage plans available to compare. Overwhelming!

Or say you live in Harris County Texas (Houston). You have 77 different Medicare Advantage plans available.

This page will help you gain the know how to be a smarter Medicare Advantage plan buyer. Thanks for the interest.

Author: Jesse Slome, Director, American Association for Medicare Supplement Insurance
Reviewed: July 10, 2024

What is Medicare Advantage (aka Part C)?

Comparing Medicare Advantage Plans

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Medicare Advantage (MA), also known as Medicare Part C, was created in 2003.

It is a type of Medicare health plan offered directly by private companies approved by Medicare. It’s coverage from these private companies – not Medicare.

These MA plans provide an alternative way to receive your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits instead of Original Medicare. Today, most Medicare Advantage Plans also include prescription drug coverage (Part D).

Most plans are offered by insurance companies. These include UnitedHealthcare and Humana. The insurance company have the flexibility to decide whether a plan will be available to all Medicare beneficiaries in a state or only in certain counties. They can also offer multiple plans within an area, each with different benefits and costs. And, each year, insurance companies have the option to join or leave the Medicare program.

There are several types of Medicare Advantage Plans available, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Special Needs Plans (SNPs), Medicare Medical Savings Accounts (MSAs), and Private Fee-for-Service Plans (PFFS). Each type of plan has its own features and network restrictions, so it’s essential to compare them carefully before choosing one that best fits your needs.

How Do Medicare Advantage Plans Work?

Here is how Medicare Advantage plans work. Plus some important considerations (ISSUES) before you sign up:

    1. Benefits Coverage: Medicare Advantage plans must provide the same benefits as Original Medicare Part A (hospitalization) and Part B (doctor’s visits). Additionally, most Medicare Advantage plans include prescription drug coverage (Part D) and often offer benefits not covered by Original Medicare, such as routine dental care, eye exams, glasses, and hearing aids. ISSUES: These can be great benefits but they vary dramatically from one company to another. Get details.
    2. Insurance Provider Network: Individuals enrolled in a Medicare Advantage plan typically have to use healthcare providers within the plan’s network for non-emergency medical care. ISSUES: There may be restrictions on choosing medical providers outside of the network.
    3. Geographic Restrictions: Many Medicare Advantage plans require that beneficiaries reside within the plan’s geographic service area to receive non-emergency medical care. ISSUES: Traveling outside this service area may impact coverage.

How Medicare Advantage Plans Work (Continued)

  1. Plan Flexibility: Unlike Original Medicare, there may be limitations on switching. ISSUES: Switching back to Original Medicare with a Medigap policy may be an issue if you have a Medicare Advantage plan. Be sure to understand how the rules apply in your area.
  2. Prior Authorization: Some procedures or tests may require approval from the Medicare Advantage plan before they can be performed. ISSUES: Required prior authorization can potentially cause delays in receiving care.
  3. Referral Requirements: In some cases, beneficiaries may need a referral from their primary care physician each time they seek specialized care under a Medicare Advantage plan. ISSUES: This requirement is not imposed on those with Original Medicare and/or Medigap.
  4. Potential Plan Changes: There is a possibility that a Medicare Advantage plan could end its coverage either by the insurer or due to changes in the provider network. ISSUES: If a plan ends, you’ll need to pick alternative options for coverage.

What Are The Different Types of Medicare Advantage Plans:

  • Health Maintenance Organizations (HMOs): HMO plans typically require you to choose a primary care physician and get referrals to see specialists. You must generally use doctors and hospitals within the HMO plan’s network except for emergencies.
  • Preferred Provider Organizations (PPOs): PPO plans allow you to see any doctor or specialist without a referral. But typically you will pay less if you use providers within the plan’s network.
  • Private Fee-for-Service (PFFS) Plans: PFFS plans determine how much they will pay doctors, hospitals, and other healthcare providers, and how much you must pay when you receive care. You can go to any Medicare-approved provider that accepts the plan’s terms.
  • Special Needs Plans (SNPs): SNPs are tailored for individuals with specific health conditions or needs. They often provide coordinated care and additional services beyond what Original Medicare covers.
  • Medicare Savings Account (MSA) Plans: MSA plans combine a high-deductible health plan with a medical savings account. The plan deposits money into the account, which you can use to pay for healthcare costs before reaching the deductible.

Who Are The Largest For Profit Insurers Offering Medicare Advantage Plans.

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Here is how 10 for-profit insurers stack up based on their national share of Medicare Advantage members:

  1. UnitedHealthcare: 27.4 percent
  2. Humana: 18.2 percent
  3. CVS Health/Aetna: 10.5 percent
  4. Anthem: 5.8 percent
  5. Centene: 4.1 percent
  6. Cigna: 2.2 percent
  7. Molina Healthcare: 0.4 percent
  8. Alignment Healthcare: 0.3 percent
  9. Essence Group: 0.3 percent
  10. Clover Health: 0.3 percent

Who Offers The Most Medicare Advantage Plans?

In 2023, the top ranking went to Humana. Humana offered Medicare Advantage plans in 2,860 counties. That marked an increase of 123 counties from 2022.

UnitedHealthcare offered Medicare Advantage plans in 2,709 counties in 2023. That was an increase of 332 from the prior year.

Blue Cross Blue Shield affiliates offered plans in 2,466 counties (2023). Up by 297 plans from 2022.

CVS Health (Aetna) offered plans in 1,978 counties, an increase of 138 counties since 2022.

Centene offered plans in 1,739 counties, an increase of 214 counties.

Cigna had MA plans in 581 counties, an increase of 104 counties.

Kaiser Permanente offered Medicare Advantage plans in 116 counties, the same as in 2022.

Comparing Medicare Advantage Plans – Some Tips!

When comparing Medicare Advantage plans, there are several key factors to consider to ensure you choose the most suitable plan for your needs. Here are some tips to help you navigate the process effectively:

  1. Understand Your Healthcare Needs: Start by assessing your healthcare needs, including any specific medications you take regularly, preferred doctors or specialists, and the type of coverage you require. This will help you narrow down your options based on what services are essential for you.
  2. Compare Costs: Evaluate the costs associated with each plan, including monthly premiums, deductibles, copayments, and coinsurance. Consider your budget and how these expenses align with your financial situation. Additionally, look at the maximum out-of-pocket limit to understand the most you would have to pay in a year.
  3. Review Coverage Options: Examine the coverage offered by each plan to ensure it includes the services and benefits you need. Compare coverage for medical services, prescription drugs, vision, dental care, hearing aids, and other additional benefits that may be important to you.

Three More Tips for Comparing Plans

  1. Check Provider Networks: Determine if your current healthcare providers are included in the plan’s network. Understand any restrictions on seeing out-of-network providers and whether referrals are needed to see specialists.
  2. Consider Star Ratings: Look at the star ratings assigned to each Medicare Advantage plan by Medicare. Higher star ratings typically indicate better quality and performance in areas such as customer service, member satisfaction, and healthcare outcomes.
  3. Explore Extra Benefits: Some Medicare Advantage plans offer extra benefits beyond Original Medicare coverage, such as wellness programs, gym memberships, telehealth services, or caregiver support. Assess these additional perks when comparing plans.
  4. Utilize Comparison Tools: Use online tools like the Medicare.gov comparison tool to input your specific information and compare multiple plans side by side. These tools can provide detailed insights into costs, coverage details, and potential savings based on your individual needs.
  5. Seek Expert Advice: If you find the process overwhelming or need personalized assistance, consider reaching out to a local Medicare Advantage agent or broker for guidance. One with experience should know what other seniors in your area have to say about the plan. They can help you navigate through the complexities of choosing a Medicare Advantage plan.

Medicare Insurance Information Statistics Resources

Access relevant Medicare insurance statistics and information using these links.

2024 Medicare Supplement Price Index – PLAN G. See the lowest and highest premium rates for top-10 U.S. markets.

PLAN N Price Index rates. Lowest and highest rates for top-10 U.S. cities.

Medicare Supplement insurance statistics – what plans people turning age 65 choose.

Find best long-term care insurance costs – free insurance quotes.