Jeffrey Wade
Medicare Advantage is an alternative to Original Medicare for health and drug coverage. Medicare Advantage plans are offered by private companies that contract with Medicare. When choosing the best insurance for Medicare Advantage, it is important to consider the costs, including copays, coinsurance, deductibles, and premiums. It is also crucial to understand the network of health providers available and whether referrals are required. Additionally, prescription drug coverage and the benefits offered, such as gym memberships or dental cleanings, should be considered. According to U.S. News, the best Medicare Advantage plans offer high-quality care, appealing benefits, and keep out-of-pocket costs low. Aetna, for example, earned a high score for its Medicare Advantage plans available in 44 states.
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What You'll Learn
- Compare costs, including premiums, copays, deductibles and out-of-pocket limits
- Prescription drug coverage—costs and pharmacy options
- Network of health providers—access to hospitals, doctors and referrals
- Insurance company ratings—US News scores, number of enrolments, and CMS scores
- Disenrolment—reasons for disenrolment and Special Enrollment Periods
Compare costs, including premiums, copays, deductibles and out-of-pocket limits
When considering Medicare Advantage, it is important to compare costs, including premiums, copays, deductibles, and out-of-pocket limits, to ensure you get the best value for your needs.
Firstly, premiums. The monthly premium for Medicare Advantage, also known as Part C coverage, varies based on the chosen policy, location, and other factors. In 2025, the average monthly premium for Medicare Advantage is projected to range from $0 to $240 or more, with an estimated average of $17 per month. It is worth noting that some plans have a $0 premium, but you may still need to pay a premium for your Part B coverage. Part B premiums may depend on your income level.
Secondly, copays. Copayments, or copays, are the fixed costs you pay each time you receive a covered service. For example, with Medicare Advantage, you typically pay a fixed copay for doctor's visits, whereas with original Medicare, you pay 20% coinsurance for Part B services.
Next, deductibles. A deductible is the amount you must spend on qualified health care costs before your insurance company begins to cover your expenses. For example, Medicare Part A, which covers hospital stays, requires you to pay $1,676 before coverage takes effect. Some Medicare Advantage plans have no deductible, but these plans tend to have higher monthly premiums. Many plans have separate deductibles for health care and prescription drugs.
Finally, out-of-pocket limits. Every plan has an annual limit, or maximum out-of-pocket (MOOP), on what you will pay out-of-pocket each year. Once you reach this limit, the insurance company covers 100% of your eligible costs for the rest of the year. The MOOP protects you from excessive medical costs due to serious or ongoing health issues.
When comparing costs, it is important to consider other factors such as prescription drug coverage, the network of health providers, and additional benefits like gym memberships or dental cleanings, which can also impact your overall expenses.
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Prescription drug coverage—costs and pharmacy options
When it comes to prescription drug coverage, costs, and pharmacy options, there are several factors to consider when choosing the best insurance for Medicare Advantage.
Firstly, it is important to understand that prescription drug coverage under Medicare is known as Medicare Part D. This coverage is optional and offered by insurance companies and private companies approved by Medicare. Medicare Part D helps cover the costs of brand-name and generic drugs. It is worth noting that even if you do not currently take prescription drugs, enrolling in Medicare Part D can help you avoid paying a late enrollment penalty if you decide to join a plan later.
The costs associated with prescription drugs under Medicare Advantage can vary. While some plans may offer a $0 premium for prescription drug coverage, it is crucial to compare all costs, including copays, coinsurance, and deductibles. For example, after meeting the Part B deductible, you typically pay up to 20% of the Medicare-approved amount for covered Part B prescription drugs. Your coinsurance amount may change depending on the price of your prescription drug, and you may pay a lower coinsurance for certain Part B-covered drugs obtained in a doctor's office, pharmacy, or outpatient setting if their prices have increased faster than the rate of inflation. Additionally, some Medicare Advantage plans may have a separate prescription drug deductible, which is the amount you need to spend on qualified prescription drug costs before the insurance company begins to cover your expenses.
When considering pharmacy options, it is essential to research which medications are covered and which pharmacies you can use to fill your prescriptions. Doctors, healthcare providers, and pharmacies must accept assignment for Part B-covered drugs, and you should not be asked to pay more than the coinsurance or copayment for the drug itself. Medicare covers certain medications, including enteral and parenteral nutrition, intravenous immune globulin (IVIG) for those with primary immune deficiency disease, and vaccinations such as flu shots, pneumococcal shots, COVID-19 vaccines, and Hepatitis B shots for certain individuals.
Lastly, it is important to consider the overall value and benefits offered by different Medicare Advantage plans. The best plans should provide high-quality care, keep out-of-pocket costs low, and include additional benefits such as gym memberships and dental cleanings, which can further reduce your overall expenses. When making your decision, pay attention to open enrollment dates, which typically run from October 15 to December 7 for initial enrollment and January 1 to March 31 for those already enrolled in a Medicare Advantage plan.
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Network of health providers—access to hospitals, doctors and referrals
When considering Medicare Advantage, it is important to understand the network of health providers you will have access to. This includes hospitals, doctors, and referrals, and will influence the insurance company and type of plan you choose.
Medicare Advantage plans are provided by private companies that contract with Medicare. These plans are an alternative to traditional or original Medicare, which allows beneficiaries to access any doctor or hospital that accepts Medicare across the United States. In contrast, Medicare Advantage enrollees can only access providers through more limited provider networks. These networks typically include doctors, hospitals, and other health providers, such as specialists or therapists.
Most Medicare Advantage plans are either Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). HMOs generally cover care provided only by in-network doctors, hospitals, and health providers, while PPOs offer access to out-of-network providers at a higher cost. It is worth noting that some Medicare Advantage plans stand out by offering broader networks, which may be appealing to those who value a wider choice of healthcare providers.
When considering a Medicare Advantage plan, it is essential to research which hospitals and doctors are included in the network and whether referrals are required for specialist care. Additionally, understanding the costs associated with out-of-network providers is crucial, as these can significantly impact your overall healthcare expenses.
Some Medicare Advantage plans offer a lower-than-required cap on out-of-pocket expenses for in-network doctor and hospital services, which can provide cost savings. However, it is important to compare all costs, including copays, coinsurance, and deductibles, across different plans to make an informed decision.
In summary, when choosing a Medicare Advantage plan, carefully consider the network of health providers to ensure you have access to the hospitals, doctors, and referrals you need. Research the specific networks offered by different insurance companies and plan types to find the option that best suits your healthcare needs and preferences.
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Insurance company ratings—US News scores, number of enrolments, and CMS scores
When it comes to insurance company ratings for Medicare Advantage plans, there are a few key metrics to consider: US News scores, the number of enrolments, and CMS scores.
US News scores are a reflection of the quality of Medicare Advantage plans offered by insurance companies. To be considered one of the best insurance companies for Medicare Advantage in 2025, a company must achieve a US News score of 3.8 or higher out of 5. Aetna, for example, earned a US News score of 4 out of 5 and offers Medicare Advantage plans in 44 states, the most out of all the winners.
The number of enrolments is also an important factor. To be considered a top-rated insurance company for Medicare Advantage, a company must have had at least 1,000 enrollees in at least 10 separate states, based on December 2023 enrollment data from the Centers for Medicare & Medicaid Services (CMS). This large number of enrollees across multiple states indicates a strong presence and popularity among Medicare beneficiaries.
CMS scores are another important metric. The Best for Screening and Prevention award, for example, recognizes companies that earn top scores from CMS for breast cancer screening, colorectal cancer screening, annual flu vaccines, controlling high blood pressure, and osteoporosis management in certain high-risk cases. This award is an indicator of the quality and comprehensiveness of the Medicare Advantage plans offered by the insurance company.
When considering a Medicare Advantage plan, it is important to look beyond the premiums and consider other factors such as copays, coinsurance, deductibles, and out-of-pocket spending limits. Additionally, understanding the network of health providers and ensuring that your chosen plan includes your preferred hospitals and doctors is crucial.
Medicare Advantage plans are an alternative to Original Medicare and provide Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. These plans are offered by private companies that contract with Medicare and may offer additional benefits such as vision, hearing, and dental services. It is important to carefully review the terms of the plan and consider all costs to make an informed decision when choosing a Medicare Advantage plan that best suits your needs.
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Disenrolment—reasons for disenrolment and Special Enrollment Periods
Disenrolment from Medicare Advantage usually occurs automatically when a person registers for a new plan. However, there are instances when disenrolment is mandatory. For example, beneficiaries may be required to disenrol if they move outside the plan's service area, lose Medicare eligibility, or if Medicare terminates a plan's contract. Similarly, beneficiaries may be involuntarily disenrolled if they fail to pay their premiums.
On the other hand, beneficiaries may choose to voluntarily disenrol from their plan if they are dissatisfied with the providers covered, if their medical needs change, or if out-of-pocket costs are too high. Research has also found that people with chronic conditions and low incomes are more likely to disenrol from Medicare Advantage plans. Plan requirements that make it difficult to navigate the healthcare system, such as needing prior authorisation for a service or limitations in coverage of out-of-network services, may also contribute to higher rates of disenrolment.
Special Enrollment Periods (SEPs) allow individuals to join or switch to a different Medicare Advantage plan outside of standard enrollment periods. SEPs typically have a two- or three-month window, triggered by specific events or qualifying life changes. For instance, you may qualify for an SEP if you move out of your plan's service area, your plan closes or stops serving your area, or you develop a disabling condition that qualifies you for a Special Needs Plan. Additionally, if you have Medicare and Medicaid, or you receive Extra Help paying for Medicare drug coverage, you can make changes to your coverage once a calendar month.
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Frequently asked questions
Medicare Advantage is an alternative to Original Medicare, providing Part A (Hospital Insurance) and Part B (Medical Insurance) benefits.
Some of the top-rated insurance companies for Medicare Advantage in 2025 include Aetna, Devoted, and other companies with a U.S. News score of 3.8 or higher and 1,000 enrollees or more in at least 10 states.
When choosing a Medicare Advantage plan, consider the costs, including premiums, copays, coinsurance, deductibles, and prescription drug coverage. Also, review the network of health providers available to you and understand the potential impact on any existing coverage, such as employer or union plans.
The open enrollment period for Medicare Advantage typically runs from October 15 to December 7 each year. However, if you already have a Medicare Advantage plan and want to make changes, the enrollment period is from January 1 to March 31.
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