Do you qualify for Medicare? You may want to consider simplifying your health insurance benefits by choosing a Medicare Advantage plan. Medicare Advantage plans are private insurance plans offered by Medicare-approved providers. Medicare Advantage plans cover all of the original benefits you receive under Original Medicare with the exception of hospice care. Hospice care is still covered under your Part A coverage.
Find Medicare Advantage Plan Providers Near You
Get custom quotes from 2-3 providers to find the best plan
The Best Companies for Medicare Advantage Plans:
- Best Overall: Kaiser Foundation Health Plan
- Cheapest: Aetna Medicare Advantage
- Best Coverage: Humana
- Best for Special Needs: Cigna
- Best for Doctor and Specialist Networks: Highmark
Medicare Advantage Plans Overview
Many Advantage plans also include additional benefits, like vision and dental protections or Medicare prescription drug coverage (sometimes called “Medicare Part D”). You may hear your medical service provider refer to Medicare Advantage plans as a Part C plan.
When you enroll with a Medicare Advantage Plan, you pay 2 premiums each month — a premium for your Advantage coverage and a separate premium for Medicare Part B coverage. Some Medicare Advantage plans have premiums as low as $0. These plans often also have higher deductibles, so you should carefully compare these plans with your income before you make a decision.
To qualify for a Medicare Advantage plan, all of the following must be true:
You already have Medicare Part A and Medicare Part B coverage.
You live in the area where your Advantage plan offers service at least 6 months of the year.
You are a citizen or legal resident of the U.S.
You don’t have end-stage renal disease (except under certain rare circumstances).
Many Americans prefer working with an Advantage Plan over Original Medicare because Advantage Plans offer a more “one-stop-shop” health care experience. Medicare Advantage often allows you to coordinate care between health care providers, which streamlines your coverage. You can also easily buy an Advantage plan that offers additional benefits like prescription drug coverage and vision coverage without worrying about paying a separate premium.
In many cases, you can save money with Advantage. Advantage plans limit what you can pay out-of-pocket for coverage. You won’t have to pay more money for your health care when you hit your yearly limit. Original Medicare has no limitations on how much you pay for your care. If you regularly require high-cost medical care, you may be able to save money when you limit your expenses with an Advantage plan.
Legalities of Medicare Advantage Plans
Medicare Advantage Plans are not government-controlled health plans. They are private plans offered by Medicare-approved providers. This means that Medicare Advantage providers have the right to limit which doctors and specialists you can see under your plan agreement. When you have Original Medicare, on the other hand, you can usually see any doctor in your area that accepts Medicare insurance. So if you have a preferred care provider that’s outside of your Advantage plan’s network, you may need to pay extra for care.
With an Advantage plan, your provider may require you to get a referral before seeing a specialist — something that’s not usually required under Original Medicare coverage. Medicare Advantage providers may also limit prescription drug coverage even if you have Part D coverage. You may need to try generic drug treatments before being treated with brand-name drugs.
Note, if you have a Medicare Advantage plan, you cannot also have a Medicare supplemental insurance plan (sometimes called a “Medigap” policy).
Keep in mind that Medicare Advantage providers also have the right to charge their own individual premiums for service. Your plan provider considers a number of factors when they calculate your premium, including where you live, whether you work in a high-risk industry and more. With this premium factor in any required copays in addition to the premium for your Medicare Part B coverage.
Shop around for plan providers and make sure you can cover your monthly premiums before you sign onto a Medicare Advantage plan.
Medicare Advantage plans must cover all of the services covered under Original Medicare. Advantage providers cannot charge you more than Original Medicare for specialized services like chemotherapy, skilled nursing or dialysis. Your Advantage provider may choose to omit coverage for procedures that aren’t deemed “medically necessary” under Medicare, however. Check with your plan provider about whether a particular treatment or procedure is covered.
Medicare Advantage plans aren’t a nationwide offering so you may see limited plan options depending on where you live. Not every Advantage provider is authorized to offer plans in every state. If you live in one state for part of the year and another state for a few months, this can leave you with a gap in coverage. Check to see which plan providers offer service in your area before you choose Advantage.
Best Medicare Insurance Providers
Do you think that a Medicare Advantage plan might be right for you? Let’s take a look at some of the best Advantage plans currently on the market.
1. Kaiser Foundation Health Plan: Best Overall
Kaiser Foundation’s health plans are ranked as some of the most valuable Medicare Advantage plans in customer satisfaction.
As of 2019, customers rate Kaiser Foundation health plans the overall best Medicare Advantage plan for 5 consecutive years in J.D. Power’s annual survey. Customers praise the company’s attention to individualized customer service, representative responsiveness, and expansive coverage and benefits.
Kaiser offers 2 levels of Medicare Advantage plans: standard Medicare Advantage and Medicare Advantage Plus that offers expanded coverage and services. With options to customize your coverage, a 5-star customer service team, and all the benefits you need, Kaiser Foundation health plans earned our top spot for Medicare Advantage coverage.
2. Aetna Medicare Advantage: Cheapest Medicare Advantage Plan
Aetna Medicare Advantage plans have some of the widest ranges of coverage available. They offer both HMO and PPO plans. If you have a doctor or specialist that you want to stay with, you can save money by choosing a more flexible plan.
Aetna offers a limited selection of special needs plans in 12 states. Their plan benefits go beyond the services offered by Original Medicare and include local healthy living resources, prescription drug deliveries and SilverSneakers fitness membership programs.
Most plans also include vision and dental coverage options. With wide availability and 24/7 on-call nursing services, Aetna is one of the best Medicare Advantage providers for individualized plan solutions.
3. Humana: Best Coverage for Medicare Advantage Plan
Do you want additional coverage beyond Original Medicare but you live on a limited income? Humana might be the right plan provider for you.
Humana offers a range of Medicare Advantage plans with $0 monthly premiums, many of which also include vision, dental and prescription drug coverage. Out-of-pocket limits with Humana are also low and options are available from $2,200 per year in maximums.
Humana Advantage plans also include a number of additional services and specials at no extra cost to you, ranging from mail delivery prescription services to SilverSneakers fitness memberships.
4. Cigna: Best for Special Needs
Some individuals have special health conditions or care needs that require more intensive treatments, personalized care treatments or more individual specialist attention.
These services may be limited under some Medicare Advantage plans. Cigna offers personalized plans that offer an increased range of services depending on your individual health needs. Special needs plans include access to a wider range of specialists, regular health assessments outside of annual physicals and care transition assistance.
Cigna is one of the country’s top choices for those living with a special medical condition, with a worldwide network of over 86 million members.
5. Highmark: Best for Doctor and Specialist Networks
One of the largest concerns that Advantage plan holders have is its coverage network. Consider a plan that offers a wider network to ensure that you can get comprehensive care no matter where you are.
Highmark offers Advantage plan holders one of the widest networks of accepted doctors and specialists. Highmark facilities are in most states in the country. Highmark even offers special health plans for those living on a Native American reserve or other protected land area — a service not offered by most other Medicare Advantage providers.
Highmark also offers a number of healthy living incentives, including a unique “Passport Rewards” program that gives you financial incentives to stay up to date with preventive care treatments and services.
Get the Coverage You Need
So, who offers the best Medicare Advantage plans? The answer depends on your individual needs and circumstances. The key to finding the best plan for you is to compare plan providers and prioritize your needs.
Have a limited income? Prioritize plan providers that offer low premiums and out-of-pocket maximums. Have a special condition that requires more personalized services? Choose a plan that offers coverage for special needs. Work with your primary care provider and your family to choose a plan that you can afford and that has the coverages you’ll use the most.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
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