What to Look for as You Shop for Medicare Advantage

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Choosing between Medicare Advantage Plans can be overwhelming due to the number of options and the intricacies surrounding healthcare coverage. A Medicare Advantage plan (Part C) is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. 

Enhanced benefits

Medicare Advantage plans can offer coverage beyond Original Medicare; this may include dental, vision, hearing, and prescription drug benefits. When you compare plans, examine what is covered (dental, gym memberships), deductibles and copayments, and coinsurance. Think about current and possible future health needs as you confirm that a policy has enough coverage.

Original Medicare has no associated provider networks, while Medicare Advantage plans typically have provider networks, including HMOs, PPOs, and private fee-for-service plans. Check to see if your preferred doctors, specialists, hospitals, and pharmacies are in the network or you could wind up with higher out-of-pocket costs linked to out-of-network care.


Shop Medicare Advantage plans that consist of premiums, deductibles, co-pays, and co-insurance. Others have higher premiums but come with lower out-of-pocket expenses. Calculate how much you might have to spend with the new plan and compare that against what you paid with your old plan given your likely needs; choose a plan that strikes the right balance between up-front costs and potential health care savings.

Part D Prescription Drug Coverage

Medicare Advantage plans usually include part coverage for the drugs you would otherwise get under Part D. Study the formulary for each plan; confirm the medicines you currently use or will need in the future are covered. Co-pays, co-insurance, and any additional requirements or restrictions to fill your medication will vary; compare all factors to make sure the plan is meeting your medication needs affordably.

Medicare Advantage plans quality ratings and Member satisfaction: CMS rates all Medicare Advantage plans each year on a 5-star rating system; with 5 stars being the highest Quality Rating. They are rated on customer service, member satisfaction, and health outcomes. Star ratings can indicate the level of care and service different plans offer. Also, be sure to read reviews and ask for recommendations from others who have tried the plans you are thinking about.

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