How do I compare Medicare Advantage plans?
No one plan fits everyone. Compare on your doctors, your medicines, your worst year of costs and how you live, and look at extras last.
- No one plan is right for everyone, because the answer turns on which doctors you see and which pills you take.
- Four checks decide it, and they are your doctors, your drug costs, the most you could pay in a year, and how you live.
- Extras like dental and vision come last, after a plan has passed all four checks.
No one plan is right for everyone. The plan that suits your neighbor can be a poor fit for you, based on which doctor you see and which pills you take. There is a steady way to find the one that fits you.
Why rankings do not help much
You will find lists that name top plans across the country. They rest on broad measures, like star ratings and member surveys. Star ratings are the yearly grades Medicare gives a plan on quality of care and customer service.
Those grades are useful background, and they cannot answer your real question. A plan with top grades may have no contract with your cardiologist. For you that is a poor plan. A plan with middling grades that covers your medicines cheaply and takes your whole medical group fits you better.
Star ratings are worth a glance. They are not the fact that decides it.
The four filters that decide it
- Network. The network is the list of doctors and hospitals the plan has a contract with. Call the billing office at each of your doctors and at your hospital. Ask if they take that exact plan next year, and do not rely on the plan directory alone.
- Formulary. The formulary is the plan's list of covered drugs, sorted into tiers, and the tier sets your share of the cost. Price your own medicines at your own pharmacy. Watch for prior authorization, where the plan approves a drug before it is filled, and step therapy, where you try a cheaper drug first.
- Out of pocket maximum. This is the most the plan can make you pay in one year for covered medical care. It tells you your worst year.
- Fit with how you live. Say so if you travel, spend part of the year away, or cross into Mexico. That points toward a Preferred Provider Organization (PPO) plan, which covers care outside the network, or toward Original Medicare with a supplement, a policy that pays the share Medicare leaves for you.
A plan that fails any one of those four is out, however good the rest of it looks. A zero premium, meaning no monthly bill of its own, is not one of the four. See what zero premium really means.
Look at the out of pocket maximum before the monthly bill. A low bill with a high yearly limit can cost you thousands more in a year you get sick.
Only then look at extras
Dental, vision, hearing, fitness, over the counter money, rides to the doctor and givebacks break a tie. Use them to pick between plans that already passed all four filters.
These features get pushed hardest in the ads, and they are the hardest to compare plan to plan. Add up in dollars only the ones you would use in a year, then compare that number.
What we can and cannot say publicly
We are an independent agency, so we work with several carriers. CMS, the federal agency that runs Medicare, sets rules on how an agency compares plans in public marketing. We cannot publish a ranking, or make claims about one plan's benefits on a page like this.
A public ranking would not help you anyway, for the reason above.
What we can do is sit down with your medicine list and your doctors, and run the plans sold at your ZIP code side by side. There is no obligation, it takes under an hour, and the answer is about you.
If you want a starting point before that talk, get your Medicare options. Enter your ZIP code and a licensed agent calls you back.
If you would rather do it yourself
That is a fair choice, and the government tool is a good one. Use the Plan Finder at Medicare.gov. Enter every medicine with its dose, add your pharmacy, and sort by total cost for the year instead of by the monthly bill.
Then call the billing office for each of your doctors and ask about the plan by name. Our step by step walkthrough goes through it.
Once you have picked a plan, follow the steps to sign up. To have someone check the network and the drug list with you, call our McAllen office at (956) 687 3334. You can also enter your ZIP code in the plan pricing box on this page.
Common follow-up questions
Why will you not just tell me the best plan?
Because the answer depends on your doctors, your prescriptions and how you live. CMS rules also limit how an agency compares plans on a public page. With your details in front of us, we can give you a direct recommendation.
Do star ratings matter?
They measure real things, like quality of care and customer service, so they are worth a look. They cannot tell you if your doctor is in the network, or what your medicines will cost. Those are the facts that decide it.
Is the most popular plan the best one?
Not always. A plan is often popular because of heavy advertising and a wide network, not because it fits your doctors and your pills.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.