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What Medicare Advantage plans are available?

There are five types of Medicare Advantage plans:

• Health maintenance organization (HMO) plans: Require you to see an in-network provider unless it’s an emergency situation, and most require a referral to see a specialist.
• Preferred provider organization (PPO) plans: Allow you to see both in-network and out-of-network health care providers, although it’s usually more expensive to go out of network. PPOs are generally networked in a local area or may expand to a wider region.
• Private fee-for-service (PFFS) plans: Allow you to see any Medicare-approved health care provider as long as they accept the plan’s payment terms and agree to see you. You may also have access to a network of providers. You can see doctors that don’t accept the plan’s payment terms, but you might pay more.
• Special needs plans (SNPs): Created to improve the management of care for Medicare beneficiaries who are either dually eligible for Medicare and Medicaid, require an institutional level of care or have certain chronic or disabling conditions, such as diabetes, chronic heart failure or dementia.
• Medical savings account (MSA) plans: Combine a high-deductible insurance plan with a medical savings account that can be used for health care costs.

What is the most highly rated Medicare Advantage plan?

All Medicare Advantage plans receive a star rating from CMS that ranges from 1 to 5 stars, with 5 stars being the best. To see which Medicare Advantage plans get the highest rating in your state, click on your state in the map below.

How to choose a Medicare Advantage plan

The Medicare Advantage plan that’s right for you will depend on your budget, the plan’s ratings, the doctors in-network, your prescription drugs and how much flexibility you want. Narrow the field of options with these strategies:

• Find the star rating. Medicare collects data on Medicare Advantage plans from member surveys, the plans themselves and health care providers, then assigns a star rating based on its findings. The star rating goes from 1 to 5 stars, with 5 stars being excellent.
• Check pricing. The two big cost considerations are a plan’s premium and the maximum out-of-pocket cost, which is the most you’ll pay in a year for covered health care. The plan maximum can be as high as $9,350 out of pocket in 2025. Look also at the deductible, which is what you’ll pay out of pocket before your insurance starts covering costs.
• Consider your meds. The plan comparison tool on Medicare.gov and some private comparison sites allow you to enter your regular prescriptions to help determine plan coverage and cost.
• Cross-reference your health care providers. If you’ve got a regular network of caregivers and medical facilities, you’ll want a plan that includes them. It’s up to you to find out if your doctors, specialists and facilities take the exact Medicare Advantage plan you’re considering. (It’s best to call them directly and ask.)
• Think about how you like to get care. If you see specialists frequently and you don’t want to request a referral for every office visit, a PPO plan will be a better option than an HMO. If you’re a light health care user and see mostly your primary care physician, an HMO might be more affordable.
• Go to the plan’s website. Before you sign up for a plan, go to the provider’s website and make sure you understand all the fine print. You may find that a plan offers dental coverage, for instance, but maxes out at $1,000 a year for comprehensive services like fillings and root canals. Look for a plan’s “Summary of Benefits” for all the details.

When can you sign up for Medicare Advantage (or change plans)?

If you’re signing up for Medicare for the first time, you can enroll in a Medicare Advantage plan during the following windows:

• During your initial enrollment period (IEP).
• During a special enrollment period (SEP), which you might qualify for if you experience a specific life event, such as retiring and leaving your employer-sponsored health coverage.
• During Medicare’s general enrollment period from Jan. 1 to March 31, if you miss your initial enrollment period and don’t qualify for a SEP.

If you already have a Medicare Advantage plan, you can change Medicare Advantage plans at following times:

• Each year during Medicare’s open enrollment from Oct. 15 to Dec. 7. (You can also join a Medicare Advantage plan during this time if you want to switch from Original Medicare.)
• Each year during Medicare Advantage open enrollment from Jan. 1 to March 31. (You can only change plans during this time if you already have a Medicare Advantage plan.)
• During a SEP, which you might qualify for if you move out of your plan’s service area or move into a nursing home, among other life events.

If you’re switching plans, you’ll be automatically unenrolled from your old plan once your new one starts.

If you have any questions about the process, you can reach the folks at Medicare at 800-MEDICARE (800-633-4227), or you can find information at Medicare.gov.

What are the pros and cons of Medicare Advantage plans?

On the plus side, Medicare Advantage plans include potentially lower premiums for coverage, limits on out-of-pocket costs, and additional benefits such as some coverage of hearing, dental and vision care.

Drawbacks include less freedom to choose your medical providers, requirements that you live and get your non-emergency medical care in the plan’s geographic service area and limits on your ability to switch back to Original Medicare with Medigap. In addition, in years where you have a major medical situation, you will need to come up with a significant amount to pay your out-of-pocket costs — up to $9,350 out of pocket in 2025.

What is the difference between Medicare and Medicare Advantage?

Original Medicare includes Medicare Part A (hospital insurance) and Part B (medical insurance), and if you want drug coverage, you’ll need Medicare Part D as well. You can buy Medicare Supplement Insurance (Medigap) to help pay for your out-of-pocket costs, and you can use any health care provider in the U.S. that accepts Medicare.

Medicare Advantage is a bundled plan that includes the same coverage as Medicare Part A, Part B, and usually Part D. Out-of-pocket costs may be lower, and plans usually offer extra benefits like vision and dental coverage. With a Medicare Advantage plan, you’ll be limited to health care providers within the plan’s network, and you’ll generally need prior authorization before seeing any specialists.

If you would like to schedule a meeting with an OC Federal licensed Medicare agent to discuss your options please contact Member Services at (888) 696-4462 to schedule your personal appointment.