The insurance company you choose to get your Medicare Advantage plan through is an important consideration. Many Medicare Advantage insurance companies offer Medicare Advantage plans, but each insurance company differs in its customer service, financial stability, and claims process.
Here is a brief overview of the top companies in 2023:
Aetna Medicare Advantage
- Aetna will provide MA coverage for 80 percent of individuals eligible for Medicare Part A and Part B. A new feature of Aetna’s Medicare Advantage plans is a zero copayment for services a beneficiary receives at Aetna’s MinuteClinics.
Cigna Medicare Advantage
- Cigna plans to expand the number of HMO Medicare Advantage plans it offers as well as its PPO Medicare Advantage plans. Its Medicare Part C plans will include the extra benefits such as disease management and wellness programs that the federal government now allows MA plans to offer.
Humana Medicare Advantage
- The number of beneficiaries enrolled in Humana Medicare Advantage plans grew to more than 3.48 million in June 2019. The company anticipates continued growth as it focuses on home-based care by partnering with organizations such as Meals on Wheels.
Medicare Advantage Plan Types
The best Medicare Advantage plan is one that fits your finances as well as your health needs. When evaluating Medicare Advantage insurance company options, compare your cost-sharing amounts: coinsurance, deductible, and copayment.
PPOs and HMOs are the two primary Medicare Advantage options available. Remember, to be eligible for either one, you must be enrolled in Medicare Part A and Part B.
Preferred Provider Organization PPO Plans
A Preferred Provider Organization must furnish the same Medicare program benefits as Original Medicare, but PPO benefits have different rules and restrictions. Here is a brief rundown of Medicare Advantage PPOs:
- Each plan establishes its copayments and deductibles.
- You might have to pay a monthly premium, or you might have a $0 premium. You may have higher rates if you have Medicare Part D coverage included in your PPO.
- PPOs have a maximum out-of-pocket limit for in-network services and also for out-of-network services.
- You do not have to choose a primary care physician (PCP).
- You do not need a referral to see a specialist.
- You pay a higher amount if you see out-of-network providers vs. in-network providers, but services are still covered.
- A Medicare Advantage PPO can offer additional benefits such as dental or hearing.
- Preferred Provider Organization PPO Plans are not available everywhere.
You typically cannot join a Preferred Provider Organization if you have end-stage renal disease ESRD. However, there are two exceptions:
- You enrolled in a Medicare Advantage PPO before you developed ESRD, and you want to stay in that plan.
- You join a Special Needs Plans SNPs tailored for ESRD beneficiaries.
Special Needs Plans are designed for beneficiaries who have chronic health conditions such as ESRD, diabetes, or heart failure. If you are dual-eligible for Medicare and Medicaid or live in institutional conditions, you can also qualify for Special Needs Plans to help cover these healthcare services.
Health Maintenance Organization HMO Plans
Contrary to Original Medicare, which allows you to see any provider nationwide as long as they participate in Medicare, a Medicare Advantage HMO requires you to seek care from a network of providers in your service area. Here are other characteristics of an HMO:
- Has a yearly maximum out-of-pocket limit for in-network services
- Referrals needed to see a specialist
- Services not covered if you go out of network (except in emergencies)
- Copayments, deductibles, and coinsurance vary by plan.
- Primary care doctor required
- Nationwide coverage for Emergency room
When can I enroll in a Medicare Advantage Plan for 2023?
- Medicare Initial Enrollment Period IEP. Your initial Medicare enrollment period is when you are first eligible for Medicare Part A and Medicare Part B. It begins three months before and ends three months after your 65th birthday.
- Medicare Initial Coverage Election Period ICEP. If you enroll in Part B when you are first eligible for Medicare Part A and Part B, then your ICEP coincides with your IEP. If you delay Part B enrollment, then your ICEP is the three months before your Part B coverage goes into effect.
- Medicare Annual Election Period AEP. The AEP runs from October 15 to December 7. During your AEP, you can change from Original Medicare to Medicare Advantage or from Medicare Advantage to Original Medicare. You can also switch Medicare Advantage plans at this time.
- Medicare Special Election Periods SEP. Special circumstances such as moving out of your service area or losing other health insurance coverage trigger an SEP. You have 60 days after qualifying for an SEP to enroll in other coverage.
- Medicare Advantage Disenrollment Period MADP. In 2019, the MADP was discontinued. The Medicare Advantage Open Enrollment Period replaces the MADP.
- Medicare Advantage Open Enrollment Period MA OEP. The MA OEP runs from January 1 through March 31. This enrollment period is only for a beneficiary already enrolled in Medicare Advantage. During this time, you can move from Original Medicare to Medicare Advantage. You can also change Medicare Advantage plans during this period. Because insurance carriers frequently make plan changes effective January 1, the MA OEP is one of the best times to compare each plan’s coverage, rates, and cost-sharing amounts.
Understanding how Social Security and Medicare Advantage insurance plans work and when you can enroll, and what the rates cover can be confusing. Feel free to call one of our licensed agents, and we will be glad to explain what you need to know. Listed below are additional Medicare resources to help you navigate your way through the health insurance maze.