Medicare Advantage Plans, also known as Medicare Part C or MA plans, are sold and administered through private companies with approval from the federal Medicare program. Medicare Advantage combines the coverage of original Medicare (Parts A and B) with additional benefits, which may include dental, vision, hearing and other coverage. Many MA plans also include prescription drug coverage, but this isn’t a guarantee.
MA plans have an out-of-pocket maximum each year and once you reach that level, the plan pays 100 percent of covered medical services. Original Medicare has no cap on what you can be required to pay out of pocket, nor does it cover medical care when you’re out of the country. Some MA plans will cover emergency care when you’re traveling, although there may be a lifetime maximum.
Original Medicare requires 20 percent coinsurance, which means you could have higher out-of-pocket costs if your medical service is expensive, especially since there’s no cap in place to keep your costs in check. MA plans normally have a fixed co-payment, such as $15 each time you see the doctor. Advantage plans may require you to see doctors in a certain network while original Medicare allows you to choose any doctor in the country, including specialists, as long as the provider accepts Medicare assignment.
Medicare beneficiaries have been able to receive Medicare benefits from private health plans since the 1970s. Initially, these benefits were primarily in the form of a health maintenance organization (HMO). The Balanced Budget Act of 1997 named this type of insurance “Medicare+Choice,” and it was renamed Medicare Advantage in the Medicare Modernization Act of 2003. In 2017, 57 million people were covered by Medicare, with 33 percent enrolled in an MA plan. The number of people enrolled in Advantage plans has more than tripled since 2004, rising from 5.3 million (13 percent) to 19.0 million (33 percent) in less than 15 years.
Companies Offering MA Plans Nationally
Medicare Advantage enrollment varies widely throughout the United States. In California, Florida, Hawaii, Minnesota, Oregon and Pennsylvania, more than 40 percent of Medicare recipients are enrolled in Medicare Advantage while 74 percent of those enrolled in Puerto Rico are in private plans. Alaska, Vermont and Wyoming have the lowest percentage of MA plan enrollees with less than 10 percent.
Not only do the number of enrollees vary by state, plans offered in each state can vary greatly. There are a few insurance companies that offer MA plans in every state, but they may not offer the same plans in each state. Some of the companies that offer plans in almost every state include:
- Blue Cross and Blue Shield
- Health Net
- Kaiser Permanente
Aetna Medicare Advantage Plans
Aetna, whose name was inspired by a volcano on the shores of Sicily, Mt. Etna, was created by merchants in 1819 who founded the Aetna Fire Insurance Company. In 1850, the company was renamed Aetna Life Insurance Company, although their products included life, property and health insurance, as well as war bonds and farm mortgages. Aetna created the first health maintenance organization (HMO) in 1973 and, by 1985, was the largest private health insurer in the country. Over the years, the company has scaled back its focus on HMOs. Since 2004, it’s pitched itself as an insurance resource that helps customers make informed choices.
Today, Aetna’s mission is to build a healthier world by helping one person, one community at a time. Nearly 38 percent of people obtain insurance from Aetna with services provided by more than 50,000 employees who are committed to providing affordable, high-quality healthcare. In recent years, Aetna has focused on government programs, such as Medicare Advantage.
Aetna offers a variety of MA plans, including traditional HMO and PPO plans. Aetna also offers an HMO-POS (Point of Sale) plan that allows you to obtain approved services outside the HMO network, though out-of-pocket costs will be higher. If you have special needs, such as end-stage renal disease, diabetes or other chronic conditions, you may be eligible for an Aetna Special Needs Plan (SNP). SNPS are required to cover prescription drugs, and benefits are designed around your specific needs. Aetna offers MA plans in all 50 states, but plan benefits vary greatly in each state.
For plan information for Aetna and the other companies listed here, we’ve used the example of a 65-year-old woman living in Broward County, Florida, who doesn’t smoke. In this case, Aetna offers three options:
- Coventry Medicare Summit Plan (HMO)
- Aetna Medicare Premier Plan (PPO)
- Aetna Medicare Choice Plan (HMO-POS)
None of these plans requires a monthly premium other than the premium you already pay for Medicare Part B (and Part A if you’re among the small percentage of Medicare enrollees with a Part A premium). There’s also no deductible for in-network providers. Keep in mind that with HMO policies, coverage isn’t guaranteed (or available at all in some cases) for providers who are outside of your plan’s network. Where these plans differ is in the cost-sharing amounts, i.e., how much you’ll be expected to cover on your own. The Coventry Medicare Summit and Aetna Medicare Choice plans, for instance, don’t have copayments for in-network primary care doctors. The Aetna Medicare Premier plan requires a $10 copay for in-network primary doctors (and $50 if the doctor isn’t in your network).
Plan availability and pricing will vary based on where you live. Remember to factor in prescription drug coverage and pricing, how much you’ll need to pay out of pocket, and other costs when you’re reviewing policies. You can check out Aetna’s plan comparison tool on its website, or get a personalized quote based on your needs.
Blue Cross and Blue Shield Medicare Advantage Plans
Blue Cross and Blue Shield is one of the most recognized health insurance companies in the world. The company was initially two separate entities with Blue Cross providing coverage for hospital services and Blue Shield providing services for doctors. Blue Cross was developed from a plan created by then-president of Baylor University’s healthcare facilities, Justin Ford Kimball, in 1929. Kimball’s plan allowed teachers to pay $6 per year for 21 days of hospital care and this was later extended to other employee groups. The Blue Cross was adopted in 1939 as an emblem for plans that met specific standards.
Blue Shield was created in the Pacific Northwest by employees of lumber and mining camps who paid monthly fees to medical service bureaus to be used for medical care. The first official plan began in California in 1939 along with the shield symbol informally used by nine plans known as the Associated Medical Care Plan. In the 1960s, the U.S. government partnered with Blue Cross and Blue Shield to administer Medicare. The two companies merged to form the Blue Cross and Blue Shield Association in 1982.
Today, Blue Cross and Blue Shield insures one in three Americans with 106 million members. More than 96 percent of hospitals and 95 percent of doctors as well as specialists contract with Blue Cross and Blue Shield companies. Health insurance is delivered through 36 independent and locally operated companies. That’s why Medicare Advantage plans offered through Blue Cross and Blue Shield may come from a company with a different name. Some of the companies include:
Blue Cross and Blue Shield offers MA plans in all 50 states, the District of Columbia and Puerto Rico. Plan types include HMOs, PPOs, Regional PPOs or private fee-for-service plans. Most of the plans offered also include wellness programs, hearing aids, vision and dental. Like all MA plans, you must continue to pay your Part B premium, and some MA plans offered through Blue Cross and Blue Shield may require an additional premium. Advantage plans may also have deductibles, copayments and coinsurance.
You can search for the Blue Cross and Blue Shield website for your state to find plans, or get a personalized quote based on your information. For our example Florida resident (a nonsmoking woman in Broward County), five plans are available from Blue Cross and Blue Shield (called Florida Blue in the Sunshine State):
- BlueMedicare Classic (HMO)
- BlueMedicare Premier (HMO)
- BlueMedicare Complete (HMO SNP)
- BlueMedicare Choice (regional PPO)
- BlueMedicare Select (PPO)
The Classic and Premier HMO plans don’t require a monthly deductible, but the other three plans do. Complete costs $29 a month, Choice costs $41 and the PPO plan costs the most at $148 a month. Each comes with its own set of deductibles, coinsurance rates and copayments. With the exception of the regional PPO plan (Choice), all of these plans cover dental, vision, hearing and prescription drug benefits. The regional PPO covers vision, hearing and prescriptions but not dental.
Because Blue Cross and Blue Shield offers MA plans through many different partner companies, plan options are different in each state. In addition, the plans are designed based on the healthiness of the subscriber. In Michigan, for example, you can choose from light plans designed for those who are fairly healthy, balanced plans for those who may have minor health issues and extended plans for those who need advanced medical care.
Cigna Medicare Advantage Plans
In 1982, Connecticut General Life Insurance Company and the Insurance Company of North America (INA), the first stock insurance company in the country, merged to form Cigna. In 2011, Cigna purchased HealthSpring Inc to begin selling Medicare plans, growing from 46,000 Medicare Advantage members to almost 400,000.
Today, Cigna is a global health service company with more than 95 million customers. The company strives to make customer experiences easy and reliable by connecting them with personal and empathetic staff members.
Cigna offers Medicare Advantage Plans with different benefits, copayments and deductibles. Half of the plans offered for 2018 had no monthly premium while others had either the same or lower premiums than those offered in 2017. Over 70 percent of the plans offered by Cigna have no copay for doctor visits. Many of the plans also include added wellness benefits through fitness programs, and more than one-third of the plans include transportation reimbursement for doctor or pharmacy visits. Some plans also offer dental, vision and hearing coverage.
Cigna’s coverage may not be statewide and it may not be available in all states. Coverage is based in the county you live in and not the state of residence. This means that you may get coverage if you live in one county in your state, but if you live or move to a different county, coverage may not be available. For example, there are no Cigna Medicare Advantage plans in Broward County. The company only offers MA plans in five counties in the northwest of the state. If you live in Santa Rosa County, though, you would find the following options from Cigna:
- Cigna-HealthSpring Advantage (HMO)
- Cigna-HealthSpring TotalCare (HMO SNP)
- Cigna-HealthSpring Premier (HMO-POS)
The Advantage HMO has no monthly premium, no primary care physician copayment and a $40 copayment for specialists. There’s no deductible for medical coverage or prescription drug coverage. The TotalCare HMO SNP has a $21 monthly premium, but no copayments for primary care doctors or specialists. It includes prescription coverage with a deductible that is the same as Medicare Part D. The Premier HMO POS has no premium each month, no copayment for primary care physicians and a $40 co-payment for specialists as long as they’re in network. For services outside the network, there’s a 30 percent coinsurance rate for primary care physicians and specialists. There may also be a $100 prescription deductible.
Humana Medicare Advantage Plans
Humana is the third-largest health insurance company in the United States with over 13 million customers. The company was founded in 1961 by David A. Jones, Sr., as Extendicare, a nursing home company. The nursing home division was sold in 1972 and the company moved into the hospital business, changing its name to Humana in 1974. In the 1980s, Humana entered the health insurance market, eventually selling the hospital division in the 1990s. Today, Medicare enrollment makes up a large portion of Humana’s total healthcare business. In Florida, more than 40 percent of Humana’s total enrollment is in MA plans.
Most of Humana Medicare Advantage plans include a nurse advice line, caregiver support, mail-delivery pharmacies and Humana community centers that support health and happiness. You can also join the SilverSneakers Fitness Program to gain access to more than 13,000 fitness centers around the world.
MA plans with Humana vary depending on where you live. Not all plans are offered in all states nor are plans the same within each state. In the Broward County, Florida, there are more options for coverage than with other companies – 11 in total for this area. Highlights include the:
- HumanaChoice PPO
- HumanaChoice Florida PPO
- Humana Gold Plus SNP-Diabetes
- Humana Gold Plus HMO
The Humana Gold Plus HMO ranks as highly popular among Humana customers, and it’s one of the best-selling plans in South Florida. There’s no monthly premium outside of what you pay for original Medicare already, no copayments for primary doctors and no deductible for medical services or prescription drugs. You’ll also have a relatively low out-of-pocket cap with this plan ($3,400), and specialist copays are just $5. The key here, as with all HMO plans, is that you must stay inside your network for coverage. Humana’s plans come in a variety of shapes and sizes, so get a personalized quote to compare your options.
Kaiser Permanente Medical Advantage Plans
Kaiser Permanente was formed during the Great Depression when Dr. Sidney Garfield realized that the thousands of men working on the Colorado River Aqueduct Project would need medical services. Using borrowed money, he built Contractors General Hospital and began treating workers who had gotten sick or injured. The economic element at the time led many insurance companies to withhold payment while a large majority of the men working in the area had no insurance at all. Because Dr. Garfield turned no one away for treatment, his expenses mounted quickly.
Harold Hatch, an insurance agent whose previous career had been engineering, suggested that the insurance companies pay a fixed amount each day per covered employee before the workers needed medical attention. Workers were provided coverage for five cents per day and, for an additional five cents per day, employees could receive coverage for illnesses and injuries unrelated to their job.
Over the years, Dr. Garfield expanded his insurance program, covering employees at the Grand Coulee Dam being built by Henry Kaiser and then shipyard workers during World War II. In 1945, the Permanente Health Plan officially became a health insurance company. The name was changed to Kaiser Permanente in 1953.
Kaiser offers Medicare Advantage plans in a handful of states. Current offerings appear in California, Colorado, Georgia, Hawaii, Maryland, Ohio, Oregon, Virginia, Washington and the District of Columbia. Plan availability varies by zip code, meaning not all Kaiser plans are available even among the states where the company sells policies. Plans vary widely between states. If you live in Georgia, for instance, you may have access to these options from Kaiser Permanente:
- Kaiser Permanente Senior Advantage Basic (HMO)
- Kaiser Permanente Senior Advantage Enhanced (HMO)
The Senior Advantage Basic HMO has no monthly premium. There’s a $7 copayment for primary doctors, $38 for specialists. Emergency room visits require an $80 copay. There is no annual deductible, and the annual out-of-pocket maximum is $5,900. The Senior Advantage Enhanced HMO has a monthly premium of $71 with $5 primary care copays and $32 specialist copays. Emergency room visits are $80, and the annual maximum out-of-pocket amount is $4,000. Neither policy requires a deductible. The Georgia Medicare Advantage plan from Kaiser also includes a senior fitness program.
UnitedHealthcare Medicare Advantage Plans
UnitedHealthcare has its roots in Charter Med Incorporated, which was founded in 1974. Charter Med began when a group of physicians and healthcare professionals decided that healthcare needed to be expanded for consumers. In 1977, the company was given the name UnitedHealthcare Corporation, thus becoming the parent company of Charter Med. From the beginning, the company was innovative in its approach to insurance, creating the first pharmacy/drug formularies, hospital admission precertification processes and software for physicians to help manage costs. In 1979, UnitedHealthcare was the first to create a network-based health plan for seniors and participated in pilot programs that offered private-market options for Medicare. AARP chose UnitedHealthcare to provide healthcare services to their members in 1997.
UnitedHealthcare provides medical benefits to consumers in all 50 states and 130 countries. It invests more than $3.3 billion annually in technology and innovation, processing more than 1 trillion transactions. The company offers both HMO and PPO plans. Although UHC offers plans in all 50 states, benefits, copayments and deductibles as well as monthly premiums vary widely from state to state and in different areas within the states. If you live in Broward County area of Southern Florida, you can choose from four plans:
- Preferred Choice Broward (HMO)
- AARP MedicareComplete Choice Plan 2 (Regional PPO)
- Medica HealthCare Plans MedicareMax (HMO)
- AARP MedicareComplete Choice Essential (Regional PPO)
The AARP MedicareComplete Choice Plan 2 Regional PPO covers care received through a network of local doctors and hospitals. You can get care outside the network, but the costs will be higher. It also includes prescription drug coverage as well as eye exams, hearing exams and hearing aids. There is no monthly premium, and primary care physician copayments are $15 (specialists are $50). There is no referral requirement to see a specialist. Tier 1 prescription drugs require only a $3 copayment.
It’s important to remember that these plans are not available in all states, and it is possible that the same plans may not be available in areas within the same state. For example, when entering a zip code for any county in Delaware, there were no MA plans available. However, entering a zip code for Prince William County, Virginia, found two plans, both HMOs. One HMO had a monthly premium of $27 and the other $87 with differences in co-payments. This demonstrates how much plans can vary by state and location.
WellCare Medicare Advantage Plans
WellCare, headquartered in Tampa, Florida, focuses on providing government-sponsored services like Medicaid and Medicare. Because it focuses specifically on government-sponsored insurance, the company has developed an expertise other insurance companies may not have. WellCare currently serves approximately 4.3 million members and provides access to almost 526,000 medical providers. You may see WellCare plans listed under one or more of the following companies:
- Care1st Health Plan Arizona
- EasyChoice Health Plan
- Exactus Pharmacy Solutions
- Heritage Health
- Staywell Kids
- Texan Plus
- Today’s Options
- WellCare Health Plans
- WellCare Healthy Connections
WellCare currently offers Medicare Advantage plans in 16 states: Arkansas, California, Connecticut, Florida, Georgia, Hawaii, Illinois, Kentucky, Louisiana, Mississippi, New Jersey, New York, South Carolina, Tennessee, Texas and Virginia. Plans vary from state to state. Florida residents in Broward County have five plan options from WellCare:
- WellCare Value (HMO-POS)
- WellCare Access (HMO SNP)
- WellCare Dividend (HMO)
- WellCare Select (HMO SNP)
- WellCare Liberty (HMO SNP)
The WellCare Value HMO-POS doesn’t have a monthly premium other than what you normally pay for original Medicare (usually just the Part B premium). There’s a $6,700 annual cap on out-of-pocket spending, and there’s no deductible. It includes prescription drug coverage. Primary doctor visits don’t require a copayment, but specialists cost $30 per visit. The plan also covers a wide range of preventive care with no additional copays. Surgery decision assistance (with a $25 incentive) and a 24-hour nurse line are included with WellCare Medicare Advantage plans.
Choosing a Medicare Advantage plan that fits your needs and stays within your budget can be tough. Plenty of companies offer a host of additional benefits and services that make Advantage a popular choice among Medicare enrollees. Consider the upfront costs, out-of-pocket spending, long-term benefits and other factors when choosing a plan. If you need help, talk to an adviser about your options, and get a personalized quote to compare rates.