Medicare is a federal health insurance program based in the US. This program aims to lower healthcare bills by providing extensive coverage for inpatient and outpatient care.
The federal government manages Medicare, and the Federal Insurance Contributions Act funds it. These extensive health insurance plans are designed to meet the ever-growing healthcare needs of senior adults aged 65 and above, those with certain disabilities, and people with end-stage renal disease (ESRD).
As of 2024, 18.5% of the US population is on Medicare. Medicare consists of various plans, such as Original Medicare, Medicare Advantage, and Medicare Supplement Plans.
Original Medicare is the standard Medicare plan comprising two parts: Part A and B. Medicare Part A is hospital insurance that provides coverage for inpatient care, such as hospital stays, skilled nursing facilities, hospice, and home health care.
In contrast, Part B provides medical coverage for outpatient care, including doctor’s visits, emergency care, labs, medical equipment, and medical supplies.
Medicare Advantage Plans are an alternative to Original Medicare and work as an all-in-one healthcare coverage option. These plans include Medicare Part A and B coverage with additional benefits such as vision, hearing, and dental care coverage. Let us look into Medicare Advantage Plans and what they offer to beneficiaries.
What Is a Medicare Advantage Plan?
Medicare Advantage Plans are also called Medicare Part C. Private insurance companies collaborate with Medicare to formulate healthcare programs for people aged 65 and above.
These plans cover Part A (hospital insurance) and Part B (medical insurance) with the addition of Part D (drug coverage).
Most Medicare Advantage Plans also provide additional benefits such as coverage for hearing, vision, and dental care. Thus, the Medicare Advantage Plan is a comprehensive private healthcare insurance option by which you receive the benefits of Original Medicare with the addition of other services.
In 2023, about half of the eligible Medicare beneficiaries (30.8 million people out of 60 million total Medicare beneficiaries) with part A and B standard coverage enrolled in Medicare Advantage Plans.
Private health insurance companies offer these Medicare Advantage Plans to beneficiaries. Therefore, enrolling yourself in a Medicare Advantage Plan means that a private provider of your choice will process your healthcare coverage.
How Does Medicare Advantage Work?
A Medicare Advantage Plan is a Medicare-approved private policy offered by a private health insurance company. This plan works as an alternative to standard coverage. Therefore, it provides hospital and medical coverage with the addition of numerous benefits, including prescription drug coverage.
When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your monthly healthcare coverage to the company that offers you your Advantage Plan. Thus, private providers must follow the rules set by Medicare.
However, these private providers have different out-of-pocket costs associated with each plan/service. In addition, Medicare Advantage Plans also operate within a specific network. Consequently, beneficiaries cannot seek treatment outside their network of choice.
You require pre-authorization or referral from your primary healthcare provider to consult a specialist outside your network.
Comparative Analysis of Top-Rated Medicare Advantage Plans of 2024
The top-rated Medicare Advantage Plans are as follows.
| Insurance Company | CMS Rating | Availability | Additional Benefits |
| Blue Cross Blue Shield | 4.17 out of 5 | Offers plans in 47 states | Dental, vision, hearing, lifestyle and transportation |
| Humana | 4.02 out of 5 | Offers plans in all 50 states | Dental, vision, hearing, lifestyle and transportation |
| Aetna | 3.87 out of 5 | Offers plans in all 50 states | Dental, vision, hearing, lifestyle and transportation |
| UnitedHealthcare | 4.06 out of 5 | Offers plans in 49 states | Dental, vision, hearing and lifestyle |
| Cigna | 4.17 out of 5 | Offers plans in 28 states | Dental, vision, hearing, lifestyle and transportation |
| Anthem | 4.19 out of 5 | Offers plans in 14 states | Dental, vision, hearing, lifestyle, holistic care and transportation |
Types of Medicare Advantage Plans
Several types of Medicare Advantage Plans are available. You can enroll in any of the following plans depending on your healthcare needs.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
- Medical Savings Accounts (MSAs)
Let us look into the details of these Medicare Advantage Plans to help you enroll into a plan that best suits your healthcare needs. If you need assistance comparing Medicare Advantage Plans in your State, Silveredge can provide you with comprehensive guidance and counseling regarding the available plans in your region and what they offer to beneficiaries.
- Health Maintenance Organizations (HMOs)
An in-network provider, typically called an HMO provider, is an approved healthcare expert within the plan’s network. In an HMO plan, beneficiaries receive care from a doctor, healthcare physician, or hospital within their network of choice.
In emergencies, beneficiaries require pre-authorization or referral from their primary healthcare provider to consult another specialist outside their network. HMO plans mostly include prescription drug coverage.
- Preferred Provider Organizations (PPOs)
PPO, another type of Medicare Advantage Plan, allows you to receive medical care from both in-network and out-of-network providers.
However, seeking out-of-network care typically costs more than your standard plan. This plan doesn’t restrict you to your primary care doctor.
You also don’t require a referral from your primary care physician to consult physicians outside your network. However, you incur relatively lower costs for medical experts and hospitals within the plan’s network.
- Special Needs Plans (SNPs)
SNPs are ideal for beneficiaries with specific diseases who require specialized healthcare. Individuals with chronic conditions, living in nursing homes, or those who have both Medicaid and Medicare receive tailored benefits.
Generally, beneficiaries are limited to the plan’s network of providers. Pre-authorization is required to consult physicians outside the network. SNPs also include prescription drug coverage.
- Private Fee-For-Service Plans (PFFS)
PFFS allows you to consult any Medicare-approved provider within your State. Hence, you’re not obligated to see a specific healthcare expert. Thus, PFFS plans work the same as Original Medicare, but you can visit any doctor at any hospital if they agree with the plan’s payment terms and conditions. These plans have fewer restrictions.
However, this plan establishes the pay rate for the doctor, the hospital, and the healthcare provider, as well as your out-of-pocket expense for the care you receive. In some PFFS, you have a network of providers where you incur lower costs. But remember, your plan may not always have prescription drug coverage.
- Medical Savings Accounts (MSAs)
A high-deductible health plan like MSA requires you to pay an out-of-pocket amount before the healthcare insurance coverage provides any benefits. A savings account is linked to this plan.
Medicare adds money to your healthcare savings account each year, which you can spend on your healthcare services. These plans lack coverage for prescription drugs and medicines.
However, they offer more flexibility in choosing healthcare providers as you don’t require referrals for consultations from specialists. This plan is ideal for people looking for more control over their healthcare expenses.
Key Differences Between Medicare Advantage Plans
The table below provides comparative information about each type of Medicare Advantage Plan.
| HMO | PPO | PFFS | SNP | MSA | |
| Premium: Is there a monthly premium? | Yes, some plans charge a premium in addition to the monthly Part B premium. | Yes, some plans charge a premium in addition to the monthly Part B premium. | Yes, some plans charge a premium in addition to the monthly Part B premium. | Yes, some plans charge a premium in addition to the monthly Part B premium. | No, you only have to pay your monthly Part B premium. |
| Drugs: Is Drug Coverage included? | Usually yes. However, if your HMO doesn’t offer drug coverage, you cannot get a separate drug plan. | Usually yes. However, if your PPO doesn’t offer drug coverage, you cannot get a separate drug plan. | Usually yes. However, if your PFFS doesn’t offer drug coverage, you can get a separate drug plan. | Yes, all SNPS must provide Medicare Drug Coverage. | No. You may join a separate Medicare drug plan. |
| Providers: Can you use any doctor/hospital that accepts Medicare? | Sometimes. You generally receive your care from in-network providers. | Yes. You can receive care from in-network and out-of-network providers. Out-of-network providers cost more. | Yes. You can receive care from any of the Medicare-approved doctors. If the plan has a network, you can use any of the network providers. Out-of-network providers cost more. | If your SNP is HMO, you must get care from the in-network providers. If your SNP is PPO, you can get out-of-network care. | Generally doesn’t have network providers. You can receive care from any Medicare-approved doctor. |
| Referral: Do you need a referral to see a specialist? | Yes | No | No | If your SNP is HMO, you require a referral. If your SNP is PPO, you don’t require a referral. | No |
What Does Medicare Advantage Plan Cover?
In 2021, out of the 58 million people enrolled in both Medicare Part A and B, about 53% of beneficiaries had traditional Medicare, while 47% had Medicare Advantage Plans.
These statistics show that Medicare Advantage offers an excellent alternative for Medicare beneficiaries to receive their healthcare benefits. Thus, the Medicare Advantage Plan is the ultimate one-stop solution to all your healthcare needs.
With this increasing number of enrollees each year, it’s crucial to look into the additional benefits these plans offer. Besides Part A (hospital services) and Part B (medical services), the Medicare Advantage Plan covers the following.
- Eyeglasses for vision
- Hearing aids
- Dental care
- Fitness programs
- Health services
- Transportation services (required for a medical purpose)
- Home health care
- Ambulance services
- Durable medical equipment
- Limited outpatient prescription drugs
- Over-the-counter drug coverage
Who Should Get a Medicare Advantage Plan?
Individuals looking for a bundled healthcare coverage option under one policy should get a Medicare Advantage Plan.
These plans consolidate the benefits and work as an excellent alternative to the standard coverage.
Moreover, Medicare Advantage Plans come with prescription drug coverage, which makes it easy to manage your healthcare under one policy.
Benefits of Medicare Advantage Plan
Here are the various benefits of a Medicare Advantage Plan.
Consolidated Coverage
Medicare Advantage Plans undoubtedly work as a bundled coverage, combining hospital insurance, medical insurance, and drug insurance with additional benefits such as coverage for vision, general fitness, and dental care.
This consolidation results in easy management of numerous healthcare needs under one policy, allowing you to navigate through your coverage without hassle.
Additional Benefits
Medicare Advantage Plans have numerous additional benefits that aren’t a part of Original Medicare or your standard coverage. These additional benefits are crucial for better health as they cater to all your needs, even if they go beyond basic medical care and hospitalization. For example, Medicare Advantage also provides wellness programs under one policy to ensure senior adults receive optimal fitness care, preventing numerous diseases.
Out-Of-Pocket Maximum
Medicare Advantage Plans protect the beneficiaries from paying excessive out-of-pocket premiums. These excessive healthcare expenses are significantly reduced as Medicare Advantage has a safety net with a maximum out-of-pocket premium per year.
Once you reach a specific limit of this maximum premium, your Medicare Advantage Plan covers 100% of medical services.
Cost Effectiveness
Medicare Advantage Plans may prove to be more cost-efficient than Original Medicare as you do not require separate drug coverage from Part D Medicare or Medigap policies.
Some Medicare Advantage Plans even offer $0 premiums, which saves you from additional costs. However, you still have to pay for coinsurance, copayments, and deductibles.
Cost of Medicare Advantage Plans
The monthly out-of-pocket amount that you pay for a Medicare Advantage Plan is called the premium. In 2024, the estimated cost of the monthly Medicare Advantage Plan is $18.5.
However, Medicare costs fluctuate according to the level of coverage, which means that you may even pay as low as $0 to as high as $505. These premiums also vary from State to State and provider to provider.
Every year, the plan sets the rate for premiums, deductibles, and services. This determines the average monthly premium for your Medicare Advantage Plan.
The plan only changes the premium once a year on January 1. But even before you can access a Medicare Advantage Plan, you must already be enrolled in Medicare Part B. Therefore, you must pay a Part B premium even if enrolling in a Medicare Advantage Plan. The estimated Part B premium is $174.70 per month as of 2024.
Eligibility Criteria for Medicare Advantage Plans
What makes you eligible for a Medicare Advantage Plan? Medicare has the same eligibility criteria across all the States. You qualify for Medicare Advantage Plans if:
- You are 65 years old or above.
- You have a medical disability.
- You have end-stage renal disease (ESRD).
- You have amyotrophic lateral sclerosis (ALS).
- Live in the plan’s service area.
- Must have Part A and Part B coverage.
- Be a US citizen or lawfully present in the US for five years.
To qualify for a Medicare Advantage Plan, you must also be approved by the Social Security Administration for either your age or disability. Moreover, you cannot have both a Medicare Advantage Plan and a Medigap policy.
Enrollment Period for Medicare Advantage Plans
Medicare has certain enrollment periods during which you can sign up for a Medicare plan or switch your existing plans. Here are different enrollment periods for Medicare Advantage Plans.
- Initial enrollment period (IEP): The initial enrollment period is 7 months, starting 3 months before your 65th birthday and ending 3 months after you turn 65. You can enroll during this period if you haven’t had Medicare before.
- General enrolment period (GEP): If you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP) between January 1 and March 31 every year. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D. During this period, you can also make changes to your current Medicare plans. For example, if you have Original Medicare and you want to switch to a Medicare Advantage Plan, you can do so during this period.
- Open enrollment period (OEP): From October 15 to December 7 each year, you can join, switch plans, or drop your coverage plans.
- Special enrollment period: Most of the time, when you join Medicare, you have to keep the plan for the entire calendar year starting on the date your coverage begins. If you want to change your Medicare Advantage Plan for any reason, such as losing your insurance or moving States, under that scenario, you might be eligible to switch plans during this period.
How to Apply for a Medicare Advantage Plan?
Before you apply for a Medicare Advantage Plan, you must already be enrolled in Medicare Part A and Part B. Therefore, you should review the Medicare Open Enrollment Period from December 15 to December 7.
You can apply for Medicare Advantage Plans online, through mail, or by visiting your nearest Social Security Office. If you have been receiving your Social Security benefits, you will automatically be enrolled in Parts A and B of Original Medicare.
You receive your Medicare ID in the mail before you turn 65th. However, if you’re new to Medicare, you can sign up during the initial enrollment period, which begins three months before your 65th birthday.
You can also apply through the Medicare Plan finder of Medicare.gov, through a private insurance provider, or by contacting licensed agents for assistance.
For a straightforward procedure, you can seek professional advice from Silveredge’s licensed advisors, as they can assist you with the enrollment procedure and help you compare the available Medicare Advantage Plans in your State.
Benefits and Limitations of Medicare Advantage Plans in 2024
Before you enroll in a Medicare Advantage Plan, you must look into the benefits and limitations these plans offer. A quick comparison can help you make an informed decision.
Here’s a quick snapshot comparison of the pros and cons of Medicare Advantage Plans 2024.
| Feature | Pros | Cons |
| Coverage | Bundled plan (Parts A, B, often D) | Limited to network providers |
| Additional Benefits | Includes coverage for dental, vision, and hearing | Benefits vary by plan; not standardized |
| Out-of-Pocket Costs | Has an out-of-pocket maximum | Potential for high costs outside of the network |
| Cost Efficiency | Can be more cost-effective than Original Medicare + Medigap | Costs vary widely, dependent on individual health needs |
| Convenience | One plan for all needs | Must see in-network providers for coverage |
| Prescription Drug Coverage | Often included, eliminating the need for a separate Part D plan | Coverage specifics vary; may not include all medications |
| Referral Requirements | Simplified access to specialists in HMO plans | HMO plans require referrals; PPO plans may have higher costs |
Find a Medicare Advantage Plan With Silveredge
Medicare Advantage Plans significantly vary from State to State and provider to provider. Therefore, it’s best to make yourself familiar with the benefits and limitations of the plans before signing up with an insurance company.
After carefully weighing the pros and cons of Medicare Advantage, you may need to assess your lifestyle, budget, medical needs, and preferred providers.
As you make your way through the complexities of Medicare, Silveredge can help simplify this process for you. Silveredge has licensed advisors that provide personalized guidance to help you understand each plan, coverage details, premiums, deductibles, and more.
A thorough understanding of a plan will allow you to make a cost-efficient and informed decision. Consider reaching out to Silveredge for expert advice to secure the best coverage option for yourself or your loved ones! Start your journey today!
