Key Factors to Consider while Choosing Medicare Advantage Plans

Medicare Advantage Plans

Medicare Advantage is a type of Medicare plan offered by private insurance companies. Original Medicare is directly administered through the federal government, whereas Medicare Advantage plan can be obtained through private insurance companies having a contract with the government. There is a wide range of Medicare Advantage plans that can be availed by a vast majority of Americans. With so many options available in the Medicare Advantage plan, you have a good chance to find an Advantage plan that best suits your healthcare needs. According to the CMS estimates, around 1200 more Medicare Advantage plans will be available in 2020 than in 2018.

What to look for when choosing a Medicare Advantage Plan?

While buying a Medicare Advantage plan, you need to consider many factors in mind, while finally enrolling in an Advantage plan. Some of the key factors are discussed below:


While shopping for Medicare Advantage plan, you need to keep the premiums, deductibles, and other costs in mind. You should be aware of the amount that you will need to pay for services like doctor visits or hospital stays. You should also know if there is a yearly limit on the amount, which you could pay out-of-pocket for medical services. You should have a clear understanding of coverage rules that may affect your costs. Medicare Advantage plans have a yearly limit on your out-of-pocket costs, and it means that once you reach this limit, then you will not require to pay anything for the covered services for the rest of the year. Thus, this option proves to be more cost-effective.

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The second crucial factor that you need to consider is the coverage. You need to know how well the Advantage plan covers the services needed by you. You must check that your chosen Advantage plan covers all of the services covered by Original Medicare and some additional services like dental, vision, and hearing.

Prescription Drugs

If you are on certain prescription drugs, then you should carefully select a Medicare Advantage plan that comes with prescription drug benefits. Most of the Medicare Advantage plans include prescription drug coverage, so you need to make sure that whether your Advantage plan includes drug coverage or not. If your Advantage plan comes with drug benefits, then you should check the plan formulary to make sure that your drugs are included in the plan’s formulary.

Doctors and Hospital Choice

Medicare Advantage plan is not accepted by all doctors and hospitals. The doctor you visit might be accepting Original Medicare enrollees, but not the enrollees of Medicare Advantage plan. Therefore, before enrolling in an Advantage plan, you should also check what doctors and hospitals are in the plan’s network, and if you visit only a particular doctor or hospital, then make sure they are part of the Advantage plan that you choose. It is common for healthcare providers to change networks each year, or even in mid of the year. It is best to check with your doctor’s office to make sure before signing up.

Understand Different Types of Advantage Plans

There are different types of Medicare Advantage plans available, and thus before choosing an Advantage plan, you should well understand the difference between these plans to pick the best plan depending upon your need.

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HMO Advantage Plan

If you enroll in the HMO Advantage plan, then you will need to stay within a network of providers.

PPO Advantage Plan

If you choose the PPO Advantage plan, then you can receive medical care from an out-of-network healthcare provider, but you will require to pay a higher cost.

Private Fee-for-Service Advantage Plan

If you are enrolled in the PFFS Advantage plan, then you don’t have access to a network, and you will need to check with each provider to see if they accept your plan for the specific medical service you receive.

HMO-POS Advantage Plan

HMO Advantage plan is like HMO, but you have the option to receive medical care from the out-of-network provider but at a higher cost that accepts Medicare.

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