Medicare Advantage, also called Plan C or an MA plan, combines all the benefits of Medicare Part A and Part B, and it often includes drug coverage, called Part D. The best Medicare Advantage plan will depend on your location, budget, overall health, and the insurer.
In this article, we look at how to sign up for Medicare Advantage, how to choose the best plan for your needs, and discuss some of the insurance providers offering the best Medicare Advantage plans.
Because Medicare is a complicated space, we recommend speaking with a licensed agent or using tools like Medicare’s plan finder to compare plans and find one that works best for your needs.
- Best for dental coverage: Humana | Skip to review
- Best for travelers: Aetna | Skip to review
- Largest network: UnitedHealthcare | Skip to review
There are a range of Medicare Advantage plans that meet different needs, including:
- Health Maintenance Organization (HMO) plans: These plans require you to choose a primary care physician (PCP) to coordinate your healthcare. You may need to get your PCP to arrange referrals to specialists. Your out-of-network coverage may be limited unless you are looking for emergency care.
- Preferred Provider Organization (PPO) plans: A PPO plan gives you more flexibility in choosing the healthcare professionals you see. You can usually see any in-network healthcare professional, including specialists, without a referral. You will have to pay more to see out-of-network professionals.
- Private Fee-for-Service (PFFS) plans: This type of plan decides how much it will pay healthcare professionals and how you pay to see them. Typically, you can see anyone who accepts the terms of this plan, but not everyone will accept PFFS plans.
- Special Needs Plans (SNPs): SNPs are for people with particular health conditions, including chronic illnesses and disabilities. They are also suitable for people who live in long-term care facilities. This type of plan coordinates specialized care.
- HMO Point-Of-Service (HMO-POS) plans: This type of plan combines the benefits of HMO and PPO plans. You will have a PCP, and it is likely you will need referrals for specialists. Seeing out-of-network healthcare professionals will cost more.
There are also Part D plans, or Medicare drug plans.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
There is no average or estimated price for any Medicare Advantage plan. Each plan varies by state, health condition, insurance company, and a variety of other factors. To get a quote for your premium, contact your chosen insurance company or the State Health Insurance Assistance Program (SHIP), which can help you find the best plan for you.
Below, we look at the best Medicare Advantage plans from popular insurance companies. We include information on state coverage, Centers for Medicare & Medicaid Services (CMS) star ratings, and the most attractive features of each plan.
It is important to note that benefits and prices will differ depending on your state and ZIP code, so we are only able to offer general information on the plans below.
Best for dental coverage: Humana
- State availability: all 50 states
- Plans available: HMO, PPO, PFFS, SNP
- CMS star rating: 4 stars
The Medicare Advantage plans from Humana include HMOs, PFFS, PPOs, and SNPs, depending on your location. The range of plans also varies by location. For instance, ZIP codes in Los Angeles have a choice of 7 plans, while ZIP codes in Virginia have over 20.
Some HMO plans offer out-of-pocket dental allowances of between $1,000 and $3,000. This includes two exams and additional work.
Humana’s HMO plans include $0 monthly premiums and out-of-pocket maximums between $2,900 and $6,400.
These plans also offer:
- a $200 or $250 glasses or contacts allowance
- worldwide emergency coverage
- 36 one-way trips to locations approved in the plan
- a SilverSneakers membership
Best for travelers: Aetna
- State availability: all 50 states
- Plans available: HMO, PPO, SNP
- CMS star rating: 4 stars
You can choose from several Medicare Advantage plans, depending on your ZIP code, including the Eagle Plan and the Eagle Plus Plan.
The Eagle Plan is an HMO plan and offers a $0 monthly premium and a maximum out-of-pocket limit of $4,200. It also includes dental, eyewear, hearing aids, fitness benefits, and acupuncture and chiropractic care.
The Eagle Plus Plan is a PPO plan. It includes $0 monthly premiums and an out-of-pocket limit of $6,700. While it doesn’t cover alternative treatments like acupuncture and chiropractic care, it does offer premium reductions for Part B services.
Both plans include telehealth and worldwide emergency coverage.
Largest network: UnitedHealthcare
- State availability: all 50 states
- Plans available: PPO, HMO-POS, SNP
- CMS star rating: 4 stars
UnitedHealthcare is known for having one of the largest networks of healthcare professionals in the United States. It states it has a network of over 1.5 million healthcare professionals and 6,200 hospitals in all 50 U.S. states.
This means you can be more flexible about who you see and where you see them, potentially simplifying your care when you need it.
There are several HMO-POS Medicare Advantage plans to choose from that offer $0 monthly premiums and out-of-pocket maximums between $800 and $4,900.
These plans also offer:
- between $750 and $1,250 for dental services
- eye exams and between a $200 and $300 eyewear allowance
- $99 copays for hearing aids
- 24 rides to the pharmacy and doctor’s visits
However, the network size and benefits offered can vary by region, so you must check what is available under UnitedHealthcare where you live.
UnitedHealthcare also offers UCard, which is a membership card. It offers credits toward food, over-the-counter (OTC) products, utility bills, and more. Some of the places people can use the UCard include:
- gyms
- PCPs and dentists
- participating food stores
| Insurer | State availability | Types of plans | CMS star rating | Premium and maximum limits |
|---|---|---|---|---|
| Humana | all 50 states | • HMO • PPO • PFFS • SNPs | 4 stars | • $0 premium • maximums between $2,900 and $6,400 |
| Aetna | all 50 states | • PPO • HMO • D-SNP | 4 stars | • $0 premium • maximums between $4,200 and $6,900 |
| UnitedHealthcare | all 50 states | • PPO • D-SNP • HMO-POS | 4 stars | • $0 premium • between $800 and $4,900 |
Below, we compare the differences between Original Medicare and Medicare Advantage.
Coverage
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Services and supplies | You will have coverage for most services and supplies in healthcare facilities. It does not cover routine physical exams, eye exams, or the majority of dental care. | Medicare Advantage plans have to cover the Original Medicare-covered medically necessary services. There may be extra benefits included in some plans. |
| Approval | In most cases, you will not need a approval to see a specialist. | You may need approval to see a specialist. |
| Part D | You can join a separate Medicare plan to get Part D coverage. | Medicare Advantage usually includes Part D. |
Cost
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Coinsurance | You will pay 20% of the Medicare-approved amounts of any Part B services you use. You must first meet your deductible. | Costs for services you pay for out-of-pocket will vary. |
| Monthly premium | You must pay the monthly premium for Part B. You will pay a separate premium for Part D. | You will pay a monthly Part B premium and potentially the plan’s premium, too. Some plans may offer $0 premiums and may help pay your Part B premium. Most plans include Part D. |
| Yearly limit | No yearly limit on out-of-pocket costs unless you have: • Medigap • Medicaid • employer, retiree, or union coverage | There is a yearly limit on services covered by Part A and Part B. There are varying limits for in-network and out-of-network services. You will not pay anything for covered services once you reach your plan’s limit. |
| Medigap | You can buy Medigap to pay for out-of-pocket costs that Medicare does not cover, including your coinsurance. You can also use coverage from your current or former employer and union coverage, or Medicaid. | It is not possible to buy Medigap to cover your out-of-pocket costs. |
Doctor and hospital choices
With Original Medicare, you can see any doctor and go to any hospital that accepts Medicare across the United States. Typically, you will not need a referral to see specialists.
With Medicare Advantage, you can only use in-network healthcare professionals who are in the plan’s service area. This excludes emergency care. You may also need to get a referral before you can see a specialist.
Travel
You will not have coverage outside of the United States with Original Medicare or Medicare Advantage. You may be able to buy Medigap to cover emergency care outside of the United States if you use Original Medicare. Some Advantage plans may have benefits that cover emergency care outside of the country.
Medicare is for people ages 65 years and over. People of any age with certain health conditions and disabilities may also be eligible. To be eligible for Medicare Advantage, you must first be eligible for Medicare. If you have Medicare Part A and Part B, you will be eligible for Medicare Advantage.
Keeping on top of your eligibility
Your eligibility may change over time depending on your location and developments the insurance company decides to make, so it is important to keep on top of any changes to your health insurance.
For instance, insurance companies may not offer Medicare Advantage to everyone with Medicare in a particular state. In fact, they may only offer it in certain counties.
Plus, insurance companies can also choose to join or leave Medicare each year, so your eligibility for Medicare Advantage may change if they choose to opt in or out. If your healthcare professional chooses to stop offering Medicare, you will have to join another Medicare plan or switch to Original Medicare.
Talk with your employer, union, or benefits administrator to understand whether your coverage will continue if you enroll in a Medicare Advantage plan. In some cases, they may stop your coverage, and you may not be able to recover it if you change your mind.
Losing employer or union coverage may also affect coverage for family members and dependents, so it is important to understand how switching to Medicare Advantage will affect your current plans.
- Consider your budget: Health insurance costs will vary widely depending on the plan you choose, your location, and the insurer you opt to enroll with. Consider your current healthcare costs, the number of prescriptions you need to fill, and how many doctor’s visits you are likely to need. Using the find a plan tool on Medicare.gov can help you find a plan that suits your finances.
- Look at your network: If there are doctors, specialists, or certain facilities you would like to keep working with, check whether your chosen Medicare Advantage plan will have them as in-network professionals.
- Think about your coverage priorities: Consider what coverage you want most, including dental, vision, hearing, prescription drugs, or other features, such as fitness memberships or transportation.
- Compare your current coverage: Look at what you are already covered for to see whether Medicare Advantage will benefit you.
- Research star ratings: Each year, the CMS releases a 5-point star rating to measure the quality of Medicare Advantage and Part D plans. Research shows that the star rating is one of the factors people value most highly when choosing a Medicare Advantage plan. You can download the CMS star rating data from CMS.gov.
How to research the best Medicare Advantage plan for you
The find a plan tool on Medicare.gov is essential when looking for the best plan for your needs. You must provide your ZIP code to start the process.
Making an account means you can compare your current coverage to new plans and save your current medications and preferred pharmacies and healthcare facilities to inform your decision.
You can also go on an insurer’s website and provide your ZIP code and, in some cases, health information to see what plans are available. There are usually phone numbers you can call and online chats to get extra advice.
You can first start the enrollment process during the initial enrolment period (IEP). This is a 7-month period that spans:
- the 3 months before you turn 65 years old
- the month of your 65th birthday
- the 3 months after your 65th birthday
For example, this means that if a person turns 65 years old in June, their IEP will run from March to September.
There is also an open enrollment period that runs from October 15 to December 7 each year. According to the Medicare website, this means that you can:
- join, drop, or switch to a different Medicare Advantage plan
- drop drug coverage
- switch from Original Medicare to Medicare Advantage
- switch from a Medicare Advantage plan to Original Medicare
- join, drop, or switch to another Medicare drug plan if you use Original Medicare
Your Medicare Advantage coverage will then begin on January 1 of the next year.
You can use your Medicare handbook or contact your local State Health Insurance Program (SHIP) to help you. SHIP offers free and personalized health insurance advice, and it is independent of any insurance provider.
Otherwise, you can enroll on insurer websites or by calling.
Five-star Medicare Advantage plans are available in 28 states, including:
- Alabama
- Arkansas
- Colorado
- Florida
- Idaho
- Illinois
- Indiana
- Kansas
- Kentucky
- Louisiana
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Nevada
- New Jersey
- New York
- North Carolina
- Ohio
- Oregon
- Pennsylvania
- Tennessee
- Texas
- Utah
- Virginia
- Wisconsin
The main disadvantages of the Medicare Advantage plans are that there are limited service providers and differences in state coverage. You’ll also need authorization for certain services and procedures. Plus, a 2022 report showed that eligible people were regularly denied services.
The benefits of a Medicare Advantage plan will differ depending on your state, ZIP code, and chosen insurance provider.
While Medicare Advantage may suit people who want to get extra benefits that Medicare does not offer, such as dental, vision, and OTC product coverage, some people find the healthcare professional network restrictive and the breadth of plans available overwhelming.
The best plans offer large healthcare professional networks, low monthly fees, coverage for your everyday health needs, travel coverage, and more. To learn which plan is best for you, try the find a plan tool.
