Once you start looking at different Medicare Advantage or Medicare Part C plans, you’ll start to see some differences in what’s covered and how much it costs. However, you also have to think about your healthcare needs and what you want to be able to do with your Medicare benefits. The costs of a Medicare Advantage plan typically are less than adding supplemental coverage and paying for Original Medicare premiums (“Original Medicare” meaning Medicare Part A and Part B plans), but that’s not always the case and depends on your income as well as how much you contributed to Medicare taxes throughout your work history.
If you want to compare Medicare Advantage plans, you should always look at these five things:
- What services are covered?
- What is the monthly premium amount?
- How much is the premium after adding Part B premium to the amount?
- What is the deductible?
- Are any extras included?
- Are prescription drugs included? If so, is it only generic?
These questions are only a few to answer when you first start comparing Medicare Advantage plans. MedicarePartC.com has a quick comparison tool that lets you check out different plans and compare benefits easily. To go a bit more in depth about how to compare these plans, this guide will walk you through each part of a Medicare Advantage or Medicare Part C Plans.
1. What Type of Plan Is It? HMO, PPO or PFFS
Most Medicare Advantage plans break down into HMO, PPO or PFFS.
HMO means Health Maintenance Organization. You must pick a primary care physician. You cannot see out-of-network doctors or facilities without paying out-of-pocket. In general, HMO’s are less expensive than PPO’s.
PPO means Preferred Provider Organization. You can pick your own doctors and medical facilities with these plans, and you can also go out-of-network. These plans generally have higher costs if you do go out-of-network.
PFFS means Pay Fee-For-Service. Any doctor or medical facility can be in your network if they accept your plan. These plans generally cost a little bit more.
Based on services, flexibility and cost, you may want to pick one type of plan over the other, which will narrow your search results greatly. HMO’s are better if you are just trying to manage your health, but if you have a need for specialist or want ideal medicine, you should pick PPO.
2. What Does the Medicare Advantage Plan Cover?
In general, Medicare Advantage plans must cover all of the services in Part A and B, which is hospital insurance and medical insurance. This means that the following are always included in Medicare Advantage Plans:
- Doctor’s visits
- Skilled nursing facility
- Urgent care
- Preventative Care
Hospice care is still covered by Medicare but not by your private health provider. In addition, Medicare Advantage plans are not available to those who have End Stage Renal Disease.
Extra services may also be covered. You can compare plans based on these extra services. Some extra services to look for may include:
- Free gym membership
- Chiropractic services
- Wellness programs
- Other discounts
Lastly, you should look at whether plans include prescription drugs and how much it costs to include them as well as what is covered. You can typically find this information under plan details for prescription drugs or Part D. Typically, you pay a higher monthly premium if prescription drugs are included.
3. Company Rating and Customer Satisfaction
Some companies just have a better report with customer satisfaction and overall history. In the health insurance field, it’s difficult to find a company without a blemish. With so many different customers, larger networks and providers generally have better company ratings because they are able to provide 24/7 service and they have a variety of
hotlines to help you if you do need some assistance. They also generally have better account management options as well online. If you find it difficult to search for plans online for a certain company, it may be even more difficult to look at your policy and pay your premiums on time if they don’t have online banking.
Customer satisfaction is another way to review different plans. While many companies have a satisfactory rating on MedicarePartC.com, it’s always important to read reviews from actual people and look for issues that repeatedly appear. Some companies don’t have it all worked out yet and may not be reliable when it comes to your healthcare needs. One thing to remember is that you are protected still under Medicare with Medicare Advantage, which means you still receive the same rights and protections as other members with Original Medicare.
4. How Much Do Medicare Advantage Plans Cost?
Costs for Medicare Advantage Plans are really simple.
Part B Premium
You still pay your Part B premium if you have one when you get a Medicare Advantage plan.
Monthly Premium through Medicare Advantage
These premiums can be nothing or go up to over $100 depending on the provider and plan. It’s best to see the benefits of each plan and what’s included before deciding on what to pay in addition to the Part B premium.
Plans also will tell you what type of deductible comes with the plan. Typically these are $500 to $1,000 depending on the plan type, but it could be nothing or lower.
Coinsurance or Co-pays
Some plans will have higher co-pays and will also cost more if you go out-of-network. You should pick plans with as little copay as possible. Preferably you don’t have to pay any type of copay to see your doctor.
Most private health plans protect you against spending too much per year out-of-pocket. Some thresholds are at $3,000 while others go as high as $6,000. You definitely want to be able to limit your out-of-pocket costs as much as possible.
5. Prescription Drug Coverage or Part D
One of the main factors in comparing Medicare Advantage (Medicare Part C) plans is which one provides a prescription drug coverage plan or Part D. These plans should cost as little as possible, but many providers charge over $100 for this supplemental coverage. If you need prescription drug coverage, you should make sure that your plan has prescription drugs covered and that costs are not too high for generic and special tier drugs. Each plan should give you a break down of what prescription drugs are covered.
When you compare different Medicare Advantage Plans, it is important to name what the most important factor is for you and your healthcare needs. If you know that you will need one doctor for a long-term care situation, then an HMO may be the best deal to go with. If you would prefer being able to seek out your own doctors and having more control, PPO and PFFS are both viable options. As always, you can compare plans on MedicarePartC.com and check out different benefits, prices, types of plans and prescription drug coverage. If you have any questions about what you find on MedicarePartC.com, you can always call 1-888-228-MEDI.
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