Medicare Advantage Plans are an alternative to Original Medicare, offered by private insurers. Here's how to shop.
Updated Sep 4, 2024 · 3 min read Written by Kate Ashford, CSA® Lead Writer Kate Ashford, CSA®
Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 20 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Assigning Editor Holly Carey
Assigning Editor | Medicare
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
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Comparing Medicare Advantage plans requires you to think about your budget, your health care needs and how you like to get care. Choosing a Medicare Advantage plan isn’t one-size-fits-all: Here’s how to think about it.
Medicare Advantage plans are a bundled alternative to Original Medicare — meaning they include Medicare Part A (hospital coverage), Medicare Part B (medical insurance) and usually Medicare Part D (drug coverage).
Also known as Medicare Part C, Medicare Advantage plans are offered by private insurers that have been approved by Medicare. Most plans offer extra benefits that aren’t covered under Original Medicare , which may include some cost sharing for dental , hearing and vision care. You’ll probably be required to stick with doctors in the plan’s network, but out-of-pocket costs may be lower.
The best place to start shopping for Medicare Advantage plans (or a Part D or Medigap policy) is on the Medicare.gov comparison tool . After answering a few questions about your location and any financial help you're receiving — from Medicaid , for instance — the tool will show you all available plans that meet your criteria.
If you want to see drug costs when you compare plans, enter the name, dosage, quantity and frequency for each drug you take regularly — and even your regular pharmacy. The final results will be populated with your expected drug costs in each plan.
Filter plans by available benefits, plan type, ratings, insurance carrier and drug coverage options. Select up to three plans for side-by-side comparison.
If you’re overwhelmed by online tools, you can find live human help from your local State Health Insurance Assistance Program (SHIP). Although SHIP volunteers can't give personalized plan recommendations, they can help guide you through choosing a plan. Each state has its own SHIP program — find yours at shiphelp.org .
There are five types of Medicare Advantage plans:
Health maintenance organization (HMO) plans : Require you to see an in-network provider unless it’s an emergency situation, and most require a referral to see a specialist.
Preferred provider organization (PPO) plans : Allow you to see both in-network and out-of-network health care providers, although it’s usually more expensive to go out of network. PPOs are generally networked in a local area or may expand to a wider region.
Private fee-for-service (PFFS) plans : Allow you to see any Medicare-approved health care provider as long as they accept the plan’s payment terms and agree to see you. You may also have access to a network of providers. You can see doctors that don’t accept the plan’s payment terms, but you might pay more.
Special needs plans (SNPs) : Created to improve the management of care for Medicare beneficiaries who are either dually eligible for Medicare and Medicaid, require an institutional level of care or have certain chronic or disabling conditions, such as diabetes, chronic heart failure or dementia.
Medical savings account (MSA) plans : Combine a high-deductible insurance plan with a medical savings account that can be used for health care costs.
All Medicare Advantage plans receive a star rating from CMS that ranges from 1 to 5 stars, with 5 stars being the best. To see which Medicare Advantage plans get the highest rating in your state, click on your state in the map below.
The Medicare Advantage plan that’s right for you will depend on your budget, the plan’s ratings, the doctors in-network, your prescription drugs and how much flexibility you want. Narrow the field of options with these strategies:
Find the star rating. Medicare collects data on Medicare Advantage plans from member surveys, the plans themselves and health care providers, then assigns a star rating based on its findings. The star rating goes from 1 to 5 stars, with 5 stars being excellent.
Check pricing. The two big cost considerations are a plan’s premium and the maximum out-of-pocket cost, which is the most you’ll pay in a year for covered health care. The plan maximum can be as high as $8,850 out of pocket in 2024 . Look also at the deductible, which is what you’ll pay out of pocket before your insurance starts covering costs.
Consider your meds. The plan comparison tool on Medicare.gov and some private comparison sites allow you to enter your regular prescriptions to help determine plan coverage and cost.
Cross-reference your health care providers. If you’ve got a regular network of caregivers and medical facilities, you’ll want a plan that includes them. It's up to you to find out if your doctors, specialists and facilities take the exact Medicare Advantage plan you're considering. (It’s best to call them directly and ask.)
Think about how you like to get care. If you see specialists frequently and you don’t want to request a referral for every office visit, a PPO plan will be a better option than an HMO. If you’re a light health care user and see mostly your primary care physician, an HMO might be more affordable.
Go to the plan’s website. Before you sign up for a plan, go to the provider’s website and make sure you understand all the fine print. You may find that a plan offers dental coverage, for instance, but maxes out at $1,000 a year for comprehensive services like fillings and root canals. Look for a plan’s “Summary of Benefits” for all the details.
