Best Medicare Advantage Providers Of 2022

Medicare Advantage is an all-in-one plan choice alternative for receiving Medicare benefits. You may also hear it referred to as Medicare Part C. This plan is bundled with Medicare Part A and Part B and usually includes Part D, which provides prescription drug coverage. Medicare pays private insurance companies to administer the benefits of Medicare Advantage plans they sell.

Some Medicare Advantage plans offer valuable additional benefits, such as:

• Vision coverage
• Dental coverage
• Hearing coverage
• Fitness program coverage (including gym memberships or discounts)
• Transportation to doctor visits
• Over-the-counter drug coverage
• Other services that promote health and wellness

You can’t be enrolled in a Medicare Advantage plan and Original Medicare at the same time. To obtain Medicare benefits you’ve earned through payroll deductions before retirement, you must choose one of these plans.

During the open enrollment period, which runs from Oct.15 to Dec. 7 each year, you can join, switch or drop a plan for your coverage to begin on Jan. 1. If you’re already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or Original Medicare during the Medicare Advantage open enrollment period, which starts on Jan. 1 and ends on March 31 annually. You can only make one switch during that time period.

If you’re already enrolled in Original Medicare (Parts A and B), you may be eligible to switch to a Medicare Advantage plan (Part C). You must be at least 65 years old or have certain disabilities, such as permanent kidney failure or amyotrophic lateral sclerosis (ALS). If the Medicare Advantage plan you choose doesn’t already have prescription drug coverage, you will have the option to enroll in Part D.

Some Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare, and some have a $0 monthly premium. Here are a few questions to consider before purchasing a plan.

• Does the plan have a monthly premium?
  • Many have a $0 premium.
  • Some pay your Part B premium.
  • If you choose a plan with a premium, it will be paid separately from your Part B premium of $148.50 (the amount for 2021).
• Does the plan have an annual or additional deductible?
• How much is the copayment for each visit or service?
• What type of health care services do you need, and how often do you get them?
• Does your service provider accept Medicare?
• What is the plan’s annual limit on out-of-pocket expenses?

Once you’re enrolled in a Medicare Advantage plan, it becomes your primary insurance. The company handles paying all your claims. And every year, the cost of your plan will probably change. The plan provider (rather than Medicare) sets the amounts charged for premiums, deductibles and services. An Annual Notice of Change (ANOC) is mailed to you each September to be effective Jan. 1.

Factors like location play a major role in determining the cost of a Medicare Advantage plan. Costs are typically lower when you use providers in your plan’s network and service area. To find the specific cost of a Medicare Advantage plan in your zip code, visit Medicare.gov.

The following example shows how plan prices can vary significantly by location. Note: Your costs may differ from these ranges even if you live near but not in one of these areas, as rates are set by ZIP code.

Medicare Advantage Plan Annual Prices by Location

Most Medicare drug plans have a coverage gap called the “donut hole,” which means there’s a temporary limit on what the drug plan will cover. “A person gets limited coverage while in the ‘donut hole.’ whether on a Medicare Advantage plan or a separate Part D plan,” says Antinea Martin-Alexander, founder of Advocate Insurance Group in South Carolina. “The individual will pay no more than 25% of the cost of the medication in the donut hole until a total out of $6,550 in out of pocket expenses is reached. There are different items that contribute to the out-of-pocket expenses while in the donut hole: any yearly drug deductible you may have, copays for any and all your medications, what the manufacturer’s discount is on that medication and what the insurance company pays for that medication,” she says.

There are four common types of Medicare Advantage plans to compare when making your selection.

Health Maintenance Organization (HMO)

• Must receive your care from providers in your plan’s network except in the case of emergency care or out-of-area dialysis
• Requires choosing a primary care provider
• Typically covers prescription drugs
• Requires specialty referrals

Preferred Provider Organization (PPO)

• Allows you to choose your service provider, but will cost more if you choose out of network
• Typically covers prescription drugs
• Doesn’t require you to select a primary care provider
• Usually doesn’t require a specialty referral

Private Fee-for-Service (PFFS)

• Allows you to choose any provider who agrees to accept PFFS plans
• Typically covers prescription drugs
• Doesn’t require you to select a primary care provider

Special Needs Plans (SNP)

• Benefits, drug coverage and provider choices are tailored to best meet the needs of the groups served by the plan.
• Membership is limited to people with specific chronic diseases or conditions that are disabling, those who require institutional or nursing home care and people who have both Medicare and Medicaid coverage.

It’s easy to switch Medicare Advantage plans if you’re already using a Medicare Advantage plan. Enroll in a new plan during one of the open enrollment periods, and your old plan will disenroll you once your new coverage begins. If you receive medical insurance through an employer or elsewhere, speak with your provider to understand how you and your family’s coverage may change while under Medicare Advantage before deciding to make the switch.

“Find a knowledgeable insurance agent,” says Joe Valenzuela, co-owner of Vista Mutual Insurance Services in the San Francisco Bay area. “Having an agent doesn’t cost the member anything. Medicare insurance agents are subject matter experts—many have spent years learning the ins and outs of each plan they represent. There are also many nuanced differences between Medicare Advantage plans. An agent can narrow down the search to only those plans that most closely align with the client’s needs.”

Valenzuela recommends asking what is most important to you when choosing a Medicare Advantage plan and keeping that priority top of mind. He also suggests paying attention to the fine print in the plan you select.

“Once you narrow your search down to one or two plans, ook through the plan’s benefits line by line—you don’t want any surprises,” he says. “For example, a plan may have a low premium and copayments but might cost you much more each month in prescription copays.”

“A couple of important benefits to look at are the plan’s annual out-of-pocket maximum (the maximum amount the member could be responsible for in a calendar year) and your prescription drug costs,” adds Valenzuela. “Check all your medications on the plan’s formulary so you’re aware of the prescription copayments, deductibles and any restrictions.”

Consider the following details when deciding whether a Medicare Advantage plan or Original Medicare is best for you.

Medicare Advantage Benefits and Drawbacks

Medicare Advantage plans have some elements you might find appealing, as well as other features that may not match your needs. Consider both the benefits and drawbacks below before enrolling in a Medicare Advantage plan.

Medicare Advantage Benefits

• Must offer at least the same level of coverage as Original Medicare
• It’s easy to switch from one Medicare Advantage plan to another if already enrolled in one.
• Costs are typically lower, with most premiums starting at $0, lower coinsurance or copayments, limits on out-of-pocket spending and potential coverage for your Part B premium.
• Many plans offer added benefits such as vision coverage, dental coverage, hearing coverage, drug coverage and fitness benefits.

Medicare Advantage Drawbacks

• Must use network providers and live in the service area for at least six months of the year.
• If you use an out-of-network provider, your costs may be higher or not covered and may go toward your out-of-pocket limit.
• Requires prior authorizations for hospital stays, procedures, home health care and medical equipment
• Requires referrals for specialists

To determine the best Medicare Advantage providers of 2022, the Forbes Health editorial team evaluated all insurance companies that offer plans nationwide in terms of:

• How many states in which they provide coverage
• Lowest costs available in terms of monthly premiums and copays (though they vary from plan to plan)
• The types of benefits they can offer (though it varies from plan to plan)
• How the Centers for Medicare and Medicaid Services (CMS) ranked their plans, using an average to represent the company as a whole
• How agencies like A.M. Best ranked them in terms of their financial health (which impacts how reliable an insurer is when it comes to paying claims)
• How agencies like J.D. Power ranked them in terms of consumer feedback

We focused exclusively on providing general summaries of the companies and their reputations. In order to provide specific plan recommendations accurately, it’s important to take into account the ZIP code and demographic details of the individual seeking insurance coverage. To do so, we recommend using Medicare.gov’s plan finder tool or seeking the expertise of an independent, agnostic insurance agent.