How to find the right Medicare Advantage plan for you

What are five-star Medicare Advantage plans?

A five-star rating indicates a high-quality, high-performance plan. Medicare rates plans from one to five stars based on several factors.

The agency uses information from healthcare providers, member satisfaction surveys and the health plans themselves to determine the ratings. Medicare Advantage plans are rated on up to 38 quality and performance measures, depending on the plan being evaluated, including:

• Breast cancer screening
• Colorectal cancer screening
• Diabetes care
• Care coordination
• Customer service

About 72% of people currently in Medicare Advantage plans with prescription drug coverage are in a plan that earned four or more stars, according to CMS.

What to think about when choosing a Medicare Advantage plan

While Medicare's rating system can steer you toward plans that rank highly on several quality and performance measures, it's still important to do your own research and find a plan that aligns best with your particular needs.

When comparing plans, pay close attention to what healthcare providers and hospitals are in the network. If you already receive care from a specific provider, double-check to make sure he or she is considered in-network under the plan. Also, call your doctor's office to make sure the provider accepts the plan before enrolling. Some providers may not accept specific Medicare Advantage plans.

Doing this extra legwork is important. Otherwise, you may incur extra costs for going out-of-network or have to switch to another provider who is within the plan's network or accepts this insurance.

Also, look at the:

• Monthly premiums, which is what you pay for the coverage.
• Deductibles, which is what you pay for health care services before the plan kicks in money.
• Coinsurance, which is your portion of the health care services costs after you reach your deductible.  
• Copayments, which are a fixed amount you pay for a Medicare-covered service.

Some plans may offer a lower monthly premium in exchange for a higher deductible and coinsurance. Some plans may have a high out-of-pocket maximum, which is the most you'll pay for covered services each year. Some plans may also have copayments. 

Plan benefits are another critical factor. Look at whether the plan offers added benefits, such as vision or dental coverage. If you take several prescription medications, see if the plan provides prescription drug coverage and what medications are listed in its formulary and covered by the insurer. If your medications aren't covered, shop around for another plan that better meets your needs.

Whether you've just become eligible for Medicare or are switching plans during a special enrollment period, you can use Medicare's Plan Finder tool to find Medicare Advantage plans offered in your area. Start there, but if you have additional questions or are unclear about potential costs or what is covered and what isn't, don't hesitate to call the insurer, talk to a representative and get clarification before you make a final decision.

Source:

• CMS. 2022 Star Ratings Fact Sheet, Accessed August 2022.
• CMS. CMS Releases 2023 Medicare Advantage and Part D Star Ratings. Accessed January 2023

Medicare Advantage and Part D plans and benefits offered by the following carriers: Accendo, ACE-Chubb, Aetna Medicare, AFLAC, Allstate - National General, Anthem Blue Cross Blue Shield, Aspire Health Plan, Capitol, Centene Corporation,  Cigna-HealthSpring, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Humana, Lumico - Elips, Manhattan Life - MAC, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare®