With so many Medicare Advantage options from different insurers to sort through, it’s easy to get bogged down in the details and get overwhelmed when time to shop for a plan comes.

This guide cuts through the confusion, helping you understand where to shop, what to look for, and how to compare Medicare Advantage plans.

We’ll help you purchase the best Medicare Advantage plan for your needs. Let’s start unpacking this!

Questions to consider when choosing a Medicare Advantage plan

Choosing a Medicare Advantage plan? Here’s a bunch of simple questions to think about. They’ll help you figure out which plan is really going to work for you.

What are my health care needs?

• Do I frequently visit specialists or primary care physicians?
• Are there specific medical conditions that I need more coverage for?

If you have a disability, chronic illness, or other medical condition that requires specialized care, there are special SNP plans that you might want to consider.

How does drug prescription coverage fit in?

• What medications am I currently taking?
• Are these medications covered under the plan’s formulary?

Every MA plan has its own list of covered drugs, so you might want to verify that the plan you are considering includes those that you need.

What’s my budget for health care?

• How much can I comfortably spend on premiums, deductibles, and copays?
• Is there a cap on out-of-pocket expenses that I need to keep in mind?
• Do I prefer lower monthly premiums even if that means higher deductibles/co-pays? 
• Or am I willing to pay a slightly higher premium for more comprehensive coverage?

Reflect on your personal payment preferences.

Is my doctor in-network?

• Are my current healthcare providers covered under this plan?
• How important is it for me to keep seeing my current doctors?
• How does the plan’s referral/authorization process work? Know if a PCP is required for specialist visits.

This will help you decide between HMO or PPO MA plans since they have different rules for in-network and out-of-network provider visits. If the doctors you know and like are part of the plan’s network and you are ok with your plan’s restrictions (e.g. having a limited choice of providers and needing a referral to see a specialist), HMO might be a good option for you (it is also cheaper). If you are ready to pay a bit more and really need the freedom to choose any provider without a referral, PPO might be the right choice for you.

What extra benefits matter most to me?

• Am I looking for dental, vision, or hearing coverage?
• Are there wellness programs or gym memberships included?

If those benefits are important to you and you know you’ll be 100% using them, look for plans that offer them.

How flexible do I need my plan to be?

• Do I travel often and need coverage in different areas?
• How easy is it to see out-of-network providers if necessary?

Make sure to check the plan’s rules for coverage outside of the service area since some plans only cover emergency care and some offer a more comprehensive coverage.

What have other enrollees said about this plan?

• Can I find reviews or ratings of the plan online?
• What do current members say about their experience with customer service and claim handling?

Reflecting on these questions will steer you towards a Medicare Advantage plan that not only meets your medical needs but also aligns with your lifestyle and budget.

Where to shop for Medicare Advantage plans?

Shopping for Medicare Advantage plans can be done through various efficient and reliable sources:

Online tools:

• Hella Health: Hella Health is a user-friendly Medicare online shopping platform. It’s like having a friend who knows all about Medicare Advantage plans. You can easily compare plans, see what each one offers, and figure out costs. Plus, HellaHealth breaks down the tricky parts, so you really understand what you’re looking at. We’ve also got great articles and guides to help you get your head around all things Medicare.
• Medicare.gov’s Plan Finder: This is a simple online tool that helps you see and compare different plans.

Local insurance agents and brokers:

• Licensed insurance agents: They offer personalized assistance to help you understand different plan options.
• Insurance brokers: Brokers can compare plans from multiple insurers, providing a broader selection.

Community seminars and health fairs:

• Medicare educational seminars: Conducted by local agents or organizations, these seminars are great for straightforward, face-to-face information.
• Health fairs: Here, you can interact directly with various plan providers.

Medicare.gov: the official source:

• 1-800-MEDICARE: The official helpline for personalized guidance and answers to your questions. Please note that they can answer questions about Medicare but not about specific plans, nor can they advise you about what plan to choose. They are not allowed to.
• Medicare & You Handbook: An annual publication providing detailed information about Medicare Advantage plans. You can find 2024 version here.

Social media and online forums:

• Medicare-specific social media groups: These can be a source of peer advice, though it’s crucial to cross-check any advice with official sources.
• Online forums: Places where people share their own experiences and tips.

Each of these options has its own good points. Whether you like looking things up online, talking to someone directly, or learning from others’ experiences, there’s a way for you to find the right plan.

Comparing Medicare Advantage plans: a step-by-step approach

Choosing the right Medicare Advantage plan can feel like a big task, but it’s a lot easier when you break it down into steps. Here’s a simple guide to help you compare plans:

Step 1: Gather your information

Before you start, have a list of your current medications, doctors, and any specific medical needs. This will help you find plans that cover what you need.

Step 2: Use the right tools to compare benefits

• Medicare.gov’s Plan Finder: This tool is a great starting point. You can enter your information and see plans available in your area. Download “Summary of Benefits” for the plans that match your priority coverage needs.
• Hella Health: Another great resource for comparing plans. It’s user-friendly and helps break down the complex parts of each plan.

Step 3: Check plan details

• Coverage: Look at what each plan covers, especially for services you use often. This includes doctor visits, hospital stays, and prescription drugs.
• Costs: Compare premiums, deductibles, and out-of-pocket maximums. Remember, a lower premium might mean higher costs elsewhere.

Step 4: Understand plan types

There are different types of Medicare Advantage plans, like HMOs and PPOs. Each type has its own rules about where you can get care and if you need referrals for specialists.

Step 5: Read reviews and ratings

• Medicare’s Star Ratings: These ratings give you an idea of a plan’s quality and performance. These take into account member satisfaction surveys, preventative care and screenings, chronic illness management, and other healthcare performance metrics. Plans with four stars or higher usually outperform the rest. Five stars are ideal if offered by a plan that meets all your other needs.
• Online Reviews: Check what other members say about their experiences with the plan.

Step 6: Consider additional benefits

Some plans offer extras like dental, vision, and wellness programs. Think about which of these benefits are important to you.

Step 7: Ask questions

If you have any doubts or questions, don’t hesitate to ask. You can talk to insurance agents, call plan providers, or use resources like SHIP for unbiased advice.

Step 8: Review annually

Your needs and plans can change. Make sure to review your plan each year during the Open Enrollment Period to ensure it still fits your needs.

Remember, taking the time to understand your options now can save you a lot of hassle later.

Making the decision: enrollment and beyond

After comparing different Medicare Advantage plans, it’s time to make your choice and look ahead. Here’s how to navigate the enrollment process and what comes next:

Deciding on a plan:

Once you’ve weighed all the factors – coverage, costs, network, and additional benefits – choose the plan that best fits your healthcare needs and budget.

Enrollment process: when to enroll?

• Initial Enrollment Period: If you’re newly eligible for Medicare, you have a 7-month period to enroll, starting 3 months before you turn 65.
• Annual Election Period (Oct 15 to Dec 7): Each year, you can change or enroll in a Medicare Advantage plan during this time.
• Medicare Advantage Open Enrollment Period (Jan 1 to Mar 31): This period is your chance to make one last change to your coverage for the starting year. If you are enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or switch back to Original Medicare (and join a separate Medicare drug plan).
• Special Enrollment Periods: Certain life events like moving or losing other health  coverage might qualify you for a special period to enroll or change plans.

How to enroll?

You can enroll through the plan’s website, Hella Health,  Medicare.gov, or by calling the plan provider. Some people prefer to enroll with the help of an insurance agent for a more guided experience.

After enrollment:

• Member ID Cards: You’ll receive a membership card from your Medicare Advantage plan. Keep this card handy, as you’ll use it instead of the red, white, and blue Medicare card when accessing healthcare services.
• Welcome Packet: Expect to get detailed plan information in the mail. This packet often includes a summary of benefits, a provider directory, and information about additional services.

Using your plan:

• Schedule a Check-Up: It’s a good idea to schedule a check-up with your primary care physician soon after your new coverage begins. This appointment can help establish your health baseline and discuss any upcoming needs.
• Managing Prescriptions: If your plan includes prescription drug coverage, check with the plan about your pharmacy options and any mail-order benefits.

Stay informed:

• Annual Notice of Change (ANOC): Each fall, your plan will send an ANOC document, detailing any changes to the plan for the upcoming year. Review this to ensure the plan still meets your needs.
• Keep Up with Plan Communications: Pay attention to any mail or emails from your plan provider. They often contain important information about benefits and policy changes.

Seek help if needed

If you have questions or issues with your plan, don’t hesitate to contact your plan’s customer service. Additionally, local SHIP counselors can offer assistance and guidance.

Your path to a great Medicare Advantage plan

And there you have it! We’ve walked through the A to Z of choosing a Medicare Advantage plan. Remember, it’s all about finding a plan that fits your health needs and your wallet.

Take your time, use the resources we’ve talked about, and don’t be shy to ask for help when you need it.