Are you overwhelmed by the flood of mail and brochures promoting the “best” Medicare Advantage plan for 2025? It’s common to receive this kind of marketing material, even when it’s not the Annual Election Period (AEP). But here’s the thing—how can a postcard or flyer really know which plan is perfect for YOU? Spoiler alert: they can’t!
There isn’t a one-size-fits-all “best” Medicare Advantage plan. The right plan for you will depend on your specific needs. It should cover your medications, include your preferred doctors in its network, and provide the benefits you’re most likely to use. No one can tell you which Medicare Advantage plan is right for you without first understanding your personal situation.
Understand How Medicare Advantage Plans Work
Before we talk about how to choose the best Medicare Advantage plan for this AEP, we need to review how the plans work.
Medicare Advantage plans can vary widely, which is why we can’t label one as the absolute best. Each plan comes with its own set of benefits, provider networks, and costs. This differs greatly from Original Medicare (Parts A and B) and Medicare Supplement plans, which offer standardized coverage across the board.
You may have heard that Medicare Advantage plans are sometimes referred to as Medicare replacement plans. While this is a helpful way to think about how they operate, it’s not entirely accurate. Medicare Advantage plans don’t permanently replace your Medicare benefits. Instead, when you choose Medicare Advantage, a private insurance company manages your benefits instead of the federal government. However, you still have the option to switch back to Original Medicare during certain enrollment periods throughout the year.
Medicare Advantage plans often feature lower monthly premiums compared to Medicare Supplement plans. In many areas, you can even find plans with $0 monthly premiums. However, this doesn’t mean the plan is free—you’ll still need to pay your Part B premium and may have additional coinsurance costs depending on your plan.
Another key aspect of Medicare Advantage plans is that most of them operate through provider networks. This means you’ll need to use healthcare providers and facilities within the plan’s network to keep your costs lower. The most common types of networks are HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations).
Finally, Medicare Advantage plans often stand out because of their extra benefits. Since private companies offer these plans, they have the flexibility to include coverage beyond what Original Medicare provides. Popular additional benefits often include dental, vision, and hearing care, as well as gym memberships.
5 Medicare Advantage Features to Consider
If we can’t tell you which Medicare Advantage plan is the best for 2024, how can you choose? The key is to find the plan that best meets your needs by evaluating these five important features that are part of every plan.
1. The Plan Network
Start by listing all your current healthcare providers, including any specialists and your dentist. Then, check to see which insurance networks each of them accept. Is there a single insurance provider they all work with, or will you need to compromise?
Keep in mind, that some plans do allow you to see out-of-network providers, but typically at a higher cost. If you’re not willing to pay more, are you comfortable switching providers? To check if your doctor is in a plan’s network, you can contact their office directly or use the carrier’s website. Network participation can change annually, so it’s important to confirm this every year during the Annual Election Period.
2. Out-of-Pocket Costs
Next, evaluate the plan’s financial aspects. While premiums are a significant factor, the costs you incur when receiving services are even more crucial. Compare deductibles and cost-sharing amounts for various plans. Consider the types of services you’re most likely to use and assess the costs associated with each plan.
It’s also important to review the plan’s maximum out-of-pocket limit (MOOP). For 2025, the out-of-pocket limit on prescription costs is $2,000, though some plans may have a lower MOOP. You’ll need to see your plan’s specific coverage to find out the MOOP of medical expenses. This limit represents the maximum amount you will pay out of pocket in a calendar year. Costs beyond this threshold will be covered by the insurance carrier.
If you don’t have sufficient savings to cover the MOOP in case of an emergency, you might want to look for a plan with a lower MOOP or consider a Medicare Supplement plan instead.
3. The Drug Formulary
Many Medicare Advantage plans come with built-in prescription drug coverage, eliminating the need for a separate Medicare Part D plan. This coverage operates similarly to a standard Part D plan.
Each Medicare Advantage plan includes a drug formulary, which is a list of covered medications organized into different tiers. These tiers indicate the cost you’ll pay for each prescription refill. When selecting a Medicare Advantage plan, verify that all your medications are included and covered at the most affordable tier. A Medicare advisor can assist you in comparing drug costs across different plans.
4. Star Ratings
Medicare Advantage star ratings are crucial but often overlooked. The Centers for Medicare and Medicaid Services (CMS) use a 5-star rating system to evaluate plans, with five stars indicating exceptional quality of care and high customer satisfaction.
While a 5-star plan might not be available in your area, that’s okay. Medicare Advantage plans with a rating of at least 3.5 stars are generally considered to offer good service and support. Additionally, if a 5-star plan becomes available in your area, you’ll have a special enrollment opportunity to switch to it.
5. Extra Benefits
While the additional perks of Medicare Advantage plans can be enticing, they should be considered last when making your decision. It’s crucial to prioritize the overall medical benefits and associated costs before focusing on extra features.
That said, once you narrow your options down to a few plans, these extra benefits can help tip the scale. Look into perks such as dental coverage, hearing and vision care, gym memberships, wellness benefits, over-the-counter allowances, transportation services, and more. These extras can add significant value and convenience, so they’re worth evaluating as you make your final choice.
Find the Medicare Advantage Plan That’s Right for You
Understanding that the best Medicare Advantage plan varies from person to person is just the beginning. With numerous factors to weigh, it’s crucial not to rush your decision when selecting a Medicare Advantage plan.
At Carolina Senior Benefits, we assist individuals like you in navigating these choices every day. Reach out to us to schedule a consultation with one of our dedicated advisors. We’ll provide personalized, unbiased guidance to help you find the Medicare plan that best meets your needs.
