How to Choose the Best Medicare Advantage Plan in 2023

Choosing the best Medicare Advantage Plan for your needs can be challenging with all the different plan options available. Here is a detailed guide on how to pick the optimal Medicare Advantage Plan in 2023.

Understand the Basics of Medicare Advantage
Medicare Advantage, also known as Medicare Part C, allows private health insurance companies to provide Medicare benefits. Medicare Advantage Plans include all coverage offered under Parts A and B. Many plans also include prescription drug coverage under Part D Drug Plan.

Medicare Advantage Plans offer lower out-of-pocket costs than Original Medicare and provide extra benefits Original Medicare doesn't cover, like dental and vision care. Instead of Original Medicare's fee-for-service structure, most Medicare Advantage Plans use provider networks and require you to see in-network doctors to get the highest level of coverage.

There are several types of Medicare Advantage Plans:

• HMO: Health Maintenance Organizations provide care through a limited network of doctors. Out-of-network care is only covered in emergencies.
  
• PPO: Preferred Provider Organizations allow you to see out-of-network doctors for a higher cost. You pay less when using in-network providers.
  
• PFFS: Private Fee-For-Service plans let you go to any Medicare-approved provider who accepts the plan's terms. Providers can decide visit-by-visit whether to accept the plan.
  
• SNP: According to centers for Medicare, Special Needs Plans provide focused care for specific populations, like people with certain chronic conditions.
  

Compare Medicare Advantage Plans in Your Area
All Medicare beneficiaries can enroll in a Medicare Advantage Plan during open enrollment from October 15 to December 7 each year for coverage starting January 1. Medicare Advantage Plans available vary based on your zip code. You can compare plans side-by-side on Medicare.gov or the plan finder tool.

When comparing many Medicare Advantage Plans, look at:

• Premiums: How much will you pay each month for the plan? Are there discounts for low-income subsidies?
• Deductibles: Plans may require you to pay a deductible amount before coverage kicks in.
• Copays and coinsurance: What will doctor visits, hospital stays, lab tests, emergency care and other services cost you?
• Maximum out-of-pocket limit: Plans cap the total amount you'll spend annually.
• Covered services: Make sure the plan covers your medications and includes extra benefits you need.
• Provider network: Are your preferred doctors and hospitals in-network? Make sure the network is sufficient.
• Prescription drug coverage: Most plans include Part D. Check formularies and pricing tiers.
• Quality ratings: Compare plan performance ratings in areas like preventative care and member satisfaction.

Medicare has a plan finder tool on their website that lets you enter your medications and preferred providers to find compatible plans. This can help narrow options.

Consider Your Health Needs Choosing a Medicare Coverage
Think about your health status and needs for the upcoming year when choosing a Medicare  Plan.

• Do you require frequent specialist visits or ongoing medical care? Then look for low specialist copays and coinsurance.
• Do you need specific prescription medications? Find plans covering those drugs at the lowest cost tier.
• Do you want additional dental, vision and hearing benefits? Choose a plan offering robust coverage.
• Do you have a chronic condition like diabetes or COPD? Look for a Special Needs Plan designed for your condition.
• Will you need medical care while traveling? Consider a PPO with out-of-network coverage.

Determine which benefits are must-haves versus nice-to-haves when assessing plans. Prioritize the plan features most important to your health needs.

Double Check Provider Networks
With Medicare Advantage Plans, you will usually pay much more to see out-of-network providers, if they are covered at all.

Before enrolling in a plan, verify that your preferred doctors, hospitals, specialists, pharmacies and other providers are in-network. Some key steps include:

• Call your healthcare providers directly to ask which Medicare Advantage Plans they accept.
  
• Search for providers on the Medicare Advantage Plan's website or provider directory.
  
• Call the plan to have them confirm providers are in-network and accepting new patients.
• Ask how much it will cost to see out-of-network providers and if referrals are required for specialists.

If a plan does not include one of your essential providers, you will likely want to choose a different plan. Make sure the plan's network will meet all your medical needs before enrolling.

Weigh Total Costs
While premiums are important, also consider the full costs you will incur under each plan based on your expected medical services.

Estimate your total costs including:

• Monthly premiums
• Deductibles
• Copays and coinsurance for hospital stays, doctor visits, diagnostic tests, emergency care, etc.
• Prescription drug expenses
• Maximum annual out-of-pocket cap

Some plans have $0 or low premiums but charge more when you need care. Other plans have higher premiums but lower cost-sharing when you use services. Run the numbers based on your anticipated healthcare utilization.

Medicare Advantage Plans must have annual limits on your out-of-pocket spending for covered medical services. Original Medicare does not have an out-of-pocket cap.

Consider Add-On Coverage
Some people enroll in a Medicare Advantage Plan and additionally buy a Medicare Supplement (Medigap) Plan or separate Part D prescription coverage. This can reduce out-of-pocket costs but increases your monthly premium expenses.

You cannot use a Medicare Supplement to pay for copays, deductibles and other costs under your Medicare Advantage Plan. The supplement can only cover Original Medicare expenses. You may want to compare costs of Medicare Advantage alone versus original Medicare Plus a Supplement Plan.

You can enroll in a stand-alone Part D Prescription Plan with most Medicare Advantage Plans to supplement the Advantage drug coverage. This can provide savings if the Part D Plan covers medications your Advantage Plan does not include, preferred pharmacies have lower costs under the Part D Plan, or you reach the coverage gap (donut hole).

Pick a Plan
Once you have researched plans, costs and coverage options, select the Medicare Advantage Plan that best fits your healthcare needs and budget. Key factors in choosing a plan include:

• Provides coverage for your doctors, hospitals and preferred pharmacies
• Covers medications and extra benefits critical for your health conditions
• Offers affordable copays, deductibles and other cost-sharing
• Includes an annual maximum out-of-pocket limit
• Fits within your budget constraints for premiums and total costs
• Receives high quality and satisfaction ratings
• Has good financial stability and strong company reputation

The optimal Medicare Advantage Plan provides comprehensive coverage you can afford to use that includes the providers and benefits most essential for your personal health profile and needs.

Enroll During Open Enrollment
You can join or switch Medicare Advantage Plans during the Medicare open enrollment period from October 15 to December 7 each year. Your coverage under the new plan will begin January 1.

If you are switching from Original Medicare to a Medicare Advantage Plan, your Original Medicare benefits will end when your new Advantage Plan coverage starts. Make sure to enroll in time to avoid any gap in coverage.

Changing Plans
Medicare Advantage open enrollment happens once a year, but there are some exceptions allowing you to switch plans mid-year:

• You can change plans or go back to Original Medicare during the Medicare Advantage open enrollment period from January 1 to March 31.
  
• People with Medicaid can switch plans once per quarter during the first 9 months of the year.
• If you move out of your plan's service area, you can enroll in a new plan.
• You can enter a 5-star rated Medicare Advantage Plan any time during the year.
  

If you already have a Medicare Advantage Plan, assess during open enrollment whether:

• Your plan still meets your needs in terms of costs, coverage, and providers.
• New plan options provide better benefits or cost savings.
• Your health situation has changed and you require a different type of plan.

Research new plans annually and be ready to switch if another Medicare Advantage Plan becomes the optimal choice based on changes in your healthcare needs, new plan options, and comparative costs.

Key Takeaways
Choosing the best Medicare Advantage Plan involves:

• Comparing all plans available in your area.
• Evaluating plan costs like premiums, copays, deductibles, and maximum out-of-pocket limits.
• Confirming providers including doctors, hospitals, pharmacies are in-network.
• Finding a plan that covers your medications and health services.
• Estimating your total anticipated costs under each plan.
• Enrolling at the right time to avoid coverage gaps.
• Assessing your plan options each year during open enrollment.

Investing time to understand and compare Medicare Advantage Plans can help you find affordable, comprehensive coverage tailored for your healthcare needs.

We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at The Insurance Space a Call at (866) 717-8683. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.