How to Pick the Best Medicare Advantage Plan for You

How to Pick the Best Medicare Advantage Plan for You

How to pick the best Medicare Advantage Plan for you.

The first three months of the year is the open enrollment period for people who are already enrolled in Medicare Advantage plans.

From Jan. 1 to March 31, Americans who are already enrolled in Medicare Advantage can:

  • Switch to Original Medicare (and enroll in a Part D plan; access to Medigap might require medical underwriting, depending on the circumstances.)
  • Switch to a different Medicare Advantage plan.


Only one plan change is allowed during this window (unlike the fall enrollment period, when a person can change their mind multiple times).

In 2021, the average Medicare beneficiary has 33 plans to pick from, five more than last year. In a handful of counties, there are more than 60 plans available. With so many choices, many people may find choosing the right one a daunting task.

However, the job can be made easier by focusing on a few important questions:

Are you eligible for the plan? вЂ” Depending on your health status, you may need a special needs plan (SNP).

These cover individuals who need an institutional level of care, those with chronic illnesses, and those who qualify for both Medicare and Medicaid. For example, until 2021 individuals with end-stage renal disease qualified only for an SNP. These plans have become increasingly available over the past four years.

Does the plan cover your providers? вЂ” A plan that doesn’t cover your physicians or pharmacies does you no good. You will face higher out-of-pocket costs if your providers are outside the plan’s network.

Does it cover the medications you need? вЂ” Check the plan’s formulary to make sure. Uncovered medications can cost you hundreds or thousands of dollars.

What is its quality rating? вЂ” Medicare rates plans on a scale of one star to five. The ratings take into account factors such as:

  • How the members rate it
  • Ease of getting appointments and medications
  • Customer service
  • Complaint history.


Look for plans that consistently receive three-star ratings or higher. 

What does it cost? вЂ” The premiums have to fit within your budget. The good news is that the government has reported that the average monthly premium will fall to $21 in 2021.

More generous plans may come with a higher price tag, so it still pays to shop around.

Does it provide dental and vision coverage? вЂ” Medicare does not cover routine dental and vision services, but many Medicare Advantage plans do.

You should investigate what the limits are, what your out-of-pocket costs will be, and whether you will need to get prior authorization for certain services. You will be responsible for knowing the plan’s requirements and getting authorizations.

Once you have answers to these questions, you can begin to narrow down your choices to a more manageable number. The next step is to look at any additional benefits a plan may offer, such as:

  • Fitness, such as gym memberships
  • Hearing aids
  • Bathroom safety devices
  • Telehealth
  • Meals
  • Transportation
  • In-home support


Plans can offer a few of these, several or none. They can limit how many you may choose, and they can restrict eligibility for some. Look for plans that cover extra benefits of special importance to you, and find out what limits they place on them.

We can work with you to get you set up with the plan that is right for you. Ask questions about anything that is unclear. We are here to help you.