When it comes to choosing a Medicare Advantage plan, there are several factors to consider. Cost is an important factor, but you should also look at the list of in-network providers, coverage for services and drugs you need, and the Centers for Medicare & Medicaid (CMS) star rating. Medicare collects data from surveys of members, plans, and healthcare providers to assign a star rating from 1 to 5 stars, with 5 stars being excellent. The plan comparison tool in Medicare, the government, and some private comparison sites allow you to enter your regular prescriptions to help determine plan coverage and cost. If you have a regular network of caregivers and medical centers, you'll want to make sure the plan includes them.
It's up to you to find out if doctors, specialists, and centers accept the exact Medicare Advantage plan you're considering. Aetna offers both HMO and PPO plans, but it's generally best to get an HMO plan. Among the plans we reviewed, Aetna's PPO plans had high peak outlays. This means that people with high medical needs could have expensive medical bills before the company starts paying 100% of the cost of covered services. According to the NAIC Complaint Index, BCBS has a strong overall performance of 14% fewer complaints than is typical for a company of its size.
Humana Medicare Advantage also stands out for its additional benefits and programs. Members have access to the popular SilverSneakers program as well as dental discounts of 20% to 60%, discounts on vision, resources for nutrition and weight loss, discounts for fall detection systems and alternative care such as acupuncture and massage. When it comes to cost and star ratings data, this can be obtained from Medicare Centers for Medicaid Services (CMS) & public use files. If you have a Medicare plan, review the Evidence of Coverage (EOC) and the Annual Notice of Change (ANOC). People concerned about access to providers should choose a PPO plan to get coverage for out-of-network care, but expect to pay more for these plans and for any out-of-network care. The goal is to find a Medicare Advantage plan that meets your needs with the right balance of monthly costs and medical benefits.
To find out what plans are available, use the Medicare Plan Finder or request personalized quotes from insurers or brokers. The type of plan you choose will affect your coverage and your costs, so it's important to be aware of network restrictions which are a key disadvantage of Medicare Advantage plans. Choosing the best Medicare Advantage plan will depend on the cost, amount of coverage, and the policy provider network. While they can't offer personalized plan recommendations, they can help you choose a plan based on your budget and how you prefer to access your health care. The variety of plan options is a big advantage for those looking for the right balance between coverage and cost. If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.
Start narrowing down your options by looking only at Medicare Advantage plans that cover prescription drugs. One advantage is that smaller companies could be better connected to the local community and invest more in the health needs of Medicare members living in the region. A Special Needs Plan (SNP) will cover all of the same Medicare services as other plans but there may be expanded coverage depending on the type of plan. Ultimately, it's up to you to find out what works best for your budget and needs.
