Speak with a Senior Care Expert Today (For Free)
(855) 481-6777
Menu
  • A
  • A
  • A
logo-icon
Table of Contents

Top Rated Assisted Living Communities by City

STATE -Select-
CITY -Select-
Written By: Richard Stockton
Page Reviewed / Updated – January 22, 2021
Expert Reviewed By: Joshua Iversen, President, Syzygy Financial LLC

Since the 1970s, some Medicare enrollees have had the option of getting their insurance plan benefits through a private provider. This could be an HMO or PPO from any of a few dozen insurers, depending on the region of the country. These Medicare Advantage plans have become increasingly popular for seniors who want some flexibility in how their services are delivered, and participation in some kind of Medicare Advantage plan topped 39%, or 24.1 million recipients, in 2020. This is expected to rise even further, until an estimated 51% of eligible seniors enroll in a Medicare Advantage plan by 2030.

Big changes occurred in 2021 for people enrolled in Medicare Advantage plans. Reforms passed between 2015 and 2018 have changed the way costs are covered and bills are handled by the private companies that offer Advantage plans, and premiums in 2022 are expected to have fallen to their lowest level since 2007, a 27.9% decrease from the high of 2017. If you are one of the tens of millions who use a Medicare Advantage plan to cover any part of your benefits, especially the Part D prescription drug plan, the 2021 changes may alter the way you get healthcare.

Medicare Advantage coverage varies by company. And the companies offering plans differ from one state to another, and in some places even from one county to another. Choosing the plan with the coverage you need could be the most important decision you make before the new changes take place. Here’s what you need to know about the 10 biggest Medicare Advantage providers.

The Basics of Medicare Advantage Plans

Medicare Advantage is a blanket term that describes many different kinds of services provided by private companies. As a rule, seniors in the United States are automatically enrolled in Medicare Part A (hospitalization services) when they turn 65. There is typically no charge for this part of Medicare. Part B covers office visits, and there may be a premium for it. Medicare Part D is a prescription drug benefit that can vary enormously in what it covers and how much a recipient is expected to pay for services.

Medicare Advantage plans, sometimes referred to as Medicare Part C, work by bundling together Parts A and B (and sometimes Part D) into a single unified plan. The major advantage of this for many seniors is the way it bundles together the sometimes complicated elements of Medicare into a single unified plan that covers all services. Medicare Advantage plans are also sometimes less expensive than paying for Parts B and D separately. The exact cost and terms of service depend on the geographic area where the senior lives, as well as the details of the plan type offered. While there are endless variations on the basic plans Medicare Advantage providers offer, Part C coverage is generally organized into one of five basic types:

Health Maintenance Organization (HMO)

HMOs have been one of the most popular ways for people to get care since the 1970s. An HMO groups together the insurance and provider services into a single unified structure, so that recipients go as a matter of course to plan doctors, in-network hospitals and often contracted pharmacies. People enrolled in an HMO often pay less than enrollees in other types of plans. This is because the costs are all in-network and there’s no need to negotiate payments with outside parties.

Preferred Provider Organization (PPO)

A PPO is the most popular alternative to an HMO. PPO plans offer relatively low-cost access to a network of providers, who are usually under contract with the PPO and derive much of their practice from the network. Unlike HMOs, PPOs typically don’t require you to designate a primary care physician to act as a first point of contact. And they allow members to seek specialist or other care outside of the network directly.

The enhanced freedom that comes with a PPO does raise the price somewhat. The Kaiser Family Foundation found that, in 2021, prescription drug plans for Medicare Advantage recipients averaged $18 a month for those with HMOs, while local PPO premiums are $25 and regional PPOs charge an average of $48 a month for similar coverage. The difference is that PPO customers often saved money on their medication purchases by shopping for less expensive pharmacies, rather than being limited to in-network outlets.

Private Fee-For-Service (PFFS)

PFFS plans are a diverse group of policies that generally provide much more flexibility in how benefits are structured. Like PPO plans, PFFS providers maintain a network of preferred practitioners who have agreed to treat plan members. And you are free to visit a provider outside of the network if you are willing to pay somewhat more. Unlike other kinds of Medicare Advantage plans, PFFS plans are not bound by Original Medicare guidelines. So the plan you choose might charge more or less than other Advantage plans. You are also allowed to buy standalone prescription coverage if you wish, which is not permitted with other types of coverage.

A PFFS plan might shift some costs toward higher monthly premiums, higher point-of-service costs or limited coverage for less common services, such as specialist care. Depending on your health and the level of medical need you have for coverage, PFFS plans can be an excellent choice for managing costs. This is because you are only required to pay for the plan’s co-pay at the time of service.

Special Needs Plan (SNP)

SNP plans provide targeted benefits for individuals with special needs. There are three categories of special needs patients who may be eligible for this coverage:

  • Institutionalized individuals
  • People with chronic or disabling medical conditions
  • “Dual-eligibles” who meet both criteria

SNPs are structured as coordinated care plans (CCPs) that meet Medicare guidelines. They must, by law, provide prescription drug coverage. SNPs can be offered by HMOs, point-of-service plans, or any other type of CCP.

Medicare Medical Savings Account (MSA)

MSA plans are private sector health savings accounts that help cover the high share of the cost of a high deductible health plan (HDHP). Medicare recipients who enroll in any type of HDHP can save a significant amount of money on monthly premiums, at the cost of having relatively expensive care at the point of service. That makes these plans attractive to many seniors who are in generally good health, but who need coverage for emergencies and sudden health concerns.

The MSA component is a type of Medicare Advantage plan that combines an HDHP with a bank account at an institution chosen by the insurance company. The company deposits a lump sum into the bank account once a year to cover authorized medical deductibles. Generally, the amount is less than the full cost of the senior’s deductibles, which leaves the recipient responsible for the rest of the cost of care. MSA deposits are tax free, provided they are spent only on approved medical care.

The 8 Best Medicare Advantage Companies

Top 8 Best Medicare Advantage Companies

Provider Available Plans Number of States Served Medicare Supplement Plans Offered with Medicare Advantage
UnitedHealthcare EPO
PPO
HMO
SNP
PFFS/POS		 25 B, C, D
Humana HMO
PPO
PFFS
SNP 		50 states, Washington, D.C., and Puerto Rico A, B, C
Aetna HMO
PPO
POS
EPO
HDHP		 46 states and Washington, D.C. Not Listed
Anthem HMO
PPO
SNP		 14 states A, B
Kaiser Permanente HMO 8 states and Washington, D.C. Not Listed
Cigna HMO (in Phoenix, AZ)
PPO (in CT, MD, OK, TX)
PFFS (in CT, MD, OK, TX)		 26 states and Washington, D.C. A, F and N (in CA)
A and C (in MI)
A and F (in NC)
Plan C (for Adults aged 50 — 64 in NJ)
Providence HMO (Only in Some Counties)
SNP (To Those Eligible)		 2 Not Listed
Premera HMO 1 D (included in HMO plan)
UnitedHealthcare

UnitedHealthcare operates from its headquarters in Minnetonka, Minnesota, where it was founded in 1974. Over the years, the company has gradually expanded its contracts with local providers into a network that includes 1.3 million doctors and over 6,000 hospitals and clinics nationwide. Today, UnitedHealthcare offers Parts B, C, and D plans for over 6 million Medicare Advantage customers in 50 states, though it has withdrawn from all but three state healthcare exchanges due to rising costs in 2016.

Medicare Advantage customers who choose UnitedHealthcare have their choice between several different plan types. The company offers:

  • EPO (UnitedHealthcare Select)
  • PPO (UnitedHealthcare Select Plus)
  • HMO (UnitedHealthcare Choice)
  • SNP (Special Needs Plans)
  • PFFS/POS (UnitedHealthcare Navigate, Charter and Compass)

What Customers Like

UnitedHealthcare customers often leave positive reviews online, with several reviewers praising the company’s professional approach to customer service and generally knowledgeable phone workers. The unified structure of this large network also creates generally smooth transitions of care, which several reviewers commended for being “hassle-free.” Premiums for many types of plan are low enough to rate mentions in the reviews, with one reviewer saying this:

“I LOVE this insurance so far. I have only used it within network providers and have had no issues with service provided. I chose the (free plan) with vision and dental. For those additional services I pay a total of $21.20 which is automatically deducted from my social security check. . . I have chosen the 90 day prescription option, which is cheaper than having my scripts filled locally.”

What Customers Don’t Like

There are only a limited number of negative reviews online for UnitedHealthcare. And those one-star reviews that do exist mostly cite trouble getting signed up as the problem. One reviewer went into detail about being unable to sign up in a timely fashion:

“I never received my insurance cards even though they said they would mail it. Then the hold time is 30 minutes or more. I actually was on hold for over 1 hour. I tried to register online and received an error message telling me to call the 800 number. The 800 number told me she couldn’t help. I had to go online. I couldn’t get it to work.”

Humana

Humana is a Louisville, Kentucky, based private health insurance company that opened its doors in 1961 as a chain of nursing homes that gradually grew into a hospital network. When one of the company’s hospitals lost a contract with a major network, Humana opened its own HMO-style insurance plan in the area. By the end of the 1980s, the insurance side of the business had grown into the company’s major division.

Humana still maintains a major HMO component to its insurance business. And customers frequently seek treatment within the network that grew out of Humana’s early franchise of healthcare facilities. Humana now offers its services in the District of Columbia and all of the states, except for Massachusetts, Minnesota and Wisconsin. The plans available in each state vary somewhat. But customers in all of Humana’s coverage zones have access to Medicare Advantage plans for Parts A, B and C. Services are delivered in a variety of types, depending on the location:

  • HMO
  • PPO
  • PFFS
  • SNP

What Customers Like

Customers who have gotten healthcare through Humana often leave reviews online. Many of the reviews left for the public are overall positive, with many five-star accounts of great service and affordable rates. One reviewer was especially positive about the way Humana customer service helped her find benefits she didn’t know about:

“Humana offers so much more than just medical coverage. They have so many different ways of offering at no cost preventive activities and other help lines. I have been with Humana for years. They have went out of their way to suggest and assist me in getting extra help medically and financially. They’ve introduced me to so much extra help that I didn’t know existed or was eligible for.”

What Customers Don’t Like

Negative reviews about Humana’s standard of care are difficult to find. But some of the less positive reviews cite difficulty finding price and coverage information. One reviewer, who left a one-star review, said,

“I spend almost one hour with a salesperson while gathered my info. When I requested a written quote regarding our conversation, she stated the company does not do those and referred me to the website. There is no dollar amount there either. It is like signing up for something then finding out what it cost and waiting another year to change.”

Aetna

Aetna was founded on May 28, 1853, as Aetna Life Insurance Company of Hartford, Connecticut. Gradually growing out into other forms of insurance, the company became one of the earliest providers of health insurance in 1899. Aetna continues to offer various kinds of insurance for non-medical customers. And since 2018 it has been a subsidiary of CVS, which is best known for its pharmacies.

Aetna operates in all 50 states, plus the District of Columbia and Puerto Rico. The company also sells insurance coverage to Americans overseas, including travelers’ health insurance that can be exchanged in a limited number of foreign countries. Most Aetna customers who sign up for the company’s Medicare Advantage plans enroll in the HMO option. Though the company also offers Medicare customers PPO, POS, EPO and HDHP options.

What Customers Like

Aetna customers rate the company relatively highly for the comprehensive nature of the services it offers. Many of the five-star reviews list the various areas of care that their plans covered as a single package. One such reviewer left this review:

I recently enrolled in Aetna Coventry Freedom Plus plan as my wife had previously done so. It has proved to be perfect for our needs, as a PPO it practically covers every medical care provider we would require including dental and vision. Although getting questions answered online via messaging can be a bit difficult for those atypical requests they do a fine job. I don’t know why anyone would ever want or need to enroll in Part D.

What Customers Don’t Like

Negative reviews about Aetna can be found online. One issue that gets mentioned in most one-star reviews is customer service’s sometimes poor communication and general lack of knowledge. One reviewer, who purchased Aetna coverage through her work in Texas, had this to say about contacting Aetna customer service:

I have spent countless hours on the phone trying to get basic coverage and claims info from their poorly trained reps and they also show little respect or kindness in how they talk to customers. The other day I was told their system crashed and that I’d get a call back. Of course, I never got a call.

Anthem

Anthem emerged in its present form in 2014, after the merger of Wellpoint and an older company called Anthem, which was based in Indianapolis, Indiana. The current iteration of Anthem is the largest provider in the Blue Cross/Blue Shield network, which insures over 40 million customers in 12 states, including California and New York.

Anthem operates under various names in different states, but altogether the company offers exclusive HMO, PPO, and SNP plans for Blue Cross/Blue Shield Association members under the name Anthem Blue Cross. The HMO option is offered for all eligible Medicare Advantage customers in participating states.

What Customers Like

Anthem Blue Cross customers who have signed up for the company’s Medicare Advantage option leave generally positive reviews about customer service and the quality of care they receive from company reps over the phone. One reviewer shared her experience in a five-star review on Consumer Affairs:

“I called customer service and spoke to Sharina. She went through all 15 bills with me and we found 2 that had not made a claim but they had billed me directly. Since I met my yearly out of pocket costs I wasn’t responsible. I am so thankful for Sharina for taking the time to help me through this mountain of bills and get a better understanding.”

What Customers Don’t Like

Many of the negative comments left by customers about Anthem are only found surrounded by more positive observations from the same customers. A typical complaint, which was itself included in a four-star review, pertained to the in-network facilities where treatment is delivered and the relatively high prices of prescription drugs:

“We like our plan. We don’t like our hospital choices. Little disappointed with some of the charges for generic drugs. Our doctors are great. We’re very happy with no premium. Takes a while to get statements from other medical places, even though they have a copay.”

Kaiser Permanente

Kaiser Permanente is the largest managed care organization in the United States. Based in Oakland, California, the group operates in Hawaii, Washington, Oregon, California, Colorado, Maryland, Virginia, Georgia and the District of Columbia. Founded in 1945 by the steel magnate Henry Kaiser, the company as it is now constructed consists of three independent entities. Local Permanente groups provide outpatient office care. Kaiser Foundation Hospitals deliver hands-on care to over 12.2 million patients in the areas where Kaiser operates. The Kaiser Foundation Health Plan manages care details for the company’s insurance customers, including Medicare Advantage recipients.

Kaiser Foundation Health Plan members who qualify for a Medicare Advantage plan can get coverage at any Kaiser Permanente facility under the foundation’s flagship HMO option. The HMO option is by far the most popular plan type the foundation offers. Members who meet the federal requirements for special needs can also get residential care through Kaiser’s SNP option.

What Customers Like

Kaiser Permanente members have endless praise for the HMO’s high level of integration and the ease with which they can move from primary care visits to hospitalization and eventually discount prescription purchases. The vertical nature of the foundation’s approach has sped up communication and reduced errors within the network, as well as created a customer experience that often gets very positive reviews on sites such as Consumer Affairs. One five-star reviewer had this to say about her experience:

“I have found KP to be a smooth running machine in all aspects. I have always had great communication with KP and my doctors; I love being able to email them with questions I have knowing I will hear back within a day or so.”

What Customers Don’t Like

Many of the negative claims made about Kaiser services on public review websites mention new healthcare workers and the poor quality of care they feel they received from inexperienced technicians. A reviewer left a one-star review with comments to this effect:

“They [mess] up my repeating prescriptions Every Time, I don’t even contact them anymore, I just go thru my pharmacist. Last blood draw was by a total rookie who had to be coached on every step, hurt like **, left a giant bruise for 5 days. Dr. ** when I mention joint pain, says ‘well, consider your age’ and ‘just take pain relief.'”

Cigna

Cigna officially launched in 1982 as the result of several mergers. Though its predecessor organization, Insurance Company of North America, was originally founded in 1792. The company offers almost every type of insurance on the market, including reinsurance plans through a subsidiary. Medicare Advantage customers have their choice between a limited HMO option in the Phoenix, Arizona, area, and PPO and PFFS options in Connecticut, Maryland, Oklahoma and Texas. The company offers Plans A, F and N in California; Plans A and C coverage in Michigan; Plans A and F in North Carolina; and Plan C for adults aged 50 to 64 in New Jersey only.

What Customers Like

Customers who have gone through Cigna for Medicare Advantage often leave praise on sites, such as Consumer Affairs, for the plan’s knowledgeable staff and high skill levels. One reviewer left a five-star review and these words of praise:

“Every single time I have phoned in order to discuss a medical issue or receive cover for an MRI or consultant visit, Cigna staff have been amazing. They are incredibly helpful and friendly. Easy to talk to, knowledgeable and just willing to listen and spend time explaining things.”

What Customers Don’t Like

Negative reviews of Cigna’s health plans often bring up issues such as denial of service or non-covered procedures. One reviewer had this experience:

“(Cigna) has sent a total of 7 different denial letters to each of my providers, even having the sheer audacity to suggest that these evaluation tests aren’t medically necessary but are experimental in nature instead.”

Providence

Providence Health of Beaverton, Oregon, is one of the smaller Medicare Advantage providers in the United States. Operating in just Oregon and Washington states, the network offers a statement of Christian faith on its website and incorporates its key values into the way it delivers healthcare. As a small network, Providence has an extremely complicated map of coverage zones. The company offers Medicare Advantage services as HMOs in some counties, with plans as low as $0 a month. But medical-only plans in some other counties in the same states. An SNP plan is available for some customers, though restrictions apply.

What Customers Like

Providence customers frequently report close contact with plan representatives during their health issues, which made many leave reviews on public websites praising the ease of reaching customer service reps when needed.

What Customers Don’t Like

Providence seems to suffer from operating on a relatively small scale, which may affect its services on every level.

Premera

Originally founded as the Washington Hospital Service, Premera has been a Blue Cross provider in the Pacific Northwest since 1969. Organized as a nonprofit healthcare corporation, Premera operates in Oregon, Alaska and Washington, which is the only state where it offers Medicare Advantage plans. All three of these plans are structured as HMOs, which provide in-network care and integral Part D coverage at network pharmacies. No standalone Part D coverage is available from Premera.

What Customers Like

Customers who have had experiences with Premera leave generally positive reviews on sites such as Yelp. One five-star review praises the company’s fast dispute resolution and good customer service:

“There was an issue with a payment that I had made that needed to be refunded, but it ended up being a problem with the health plan portal not Premera. After speaking with them, they were extremely helpful and prompt in fixing things. Very happy with my experience with their customer service.”

What Customers Don’t Like

Premera customers who leave negative reviews often cite the company’s reluctance to pay in a timely manner for claims made out of network. One single-star reviewer complained:

“They do everything possible to avoid paying legitimate in-network claims. They lose things, they forget things, they wait thirty to sixty days to pay a claim and when they make a mistake, they start the payment clock all over again.”

How To Choose a Medicare Advantage Plan

There are many factors to consider when choosing a Medicare Advantage Plan. To help, we identified four questions to ask as you make this important decision.

How Much Can I Spend on Medicare Advantage?

Unlike Original Medicare, which has no limit on how much you pay out-of-pocket per year, Medical Advantage plans do have a yearly limit. After you reach this limit, you will not be responsible for paying for covered services through the remainder of the year. When considering the potential costs, it’s important to look at monthly premiums, deductibles, doctor visit copays, and the out-of-pocket maximum for in-network and out-of-network providers. These costs vary greatly depending on your state of residence, the type of Medicare Advantage plan, and the specific benefits included in the plan. Taking the time to add up these costs early on will help you narrow down your choices into what fits best into your budget.

Which Plans Cover the Services and Medications I Need?

If you find yourself needing more than just the basics covered in Medicare Part A (hospital stay) and Part B (medical coverage), then you are likely looking into a Medicare Advantage plan to fill that gap. However, these plans are not one-size-fits-all, so research is needed to determine which ones offer the services you need. Some Medicare Advantage plans include benefits such as prescription drug coverage (Part D), mental health care, and routine vision, hearing, and dental care. Others offer even more with fitness memberships, help finding a doctor, transportation to doctor appointments, and 24/7 access to communicate with a nurse. Before you dive into comparing different Medicare Advantage plans, it’s a good idea to first establish a list of all services and medications for which you would like to receive coverage.

Which Healthcare Providers Participate in the Plan’s Network?

Some Medicare Advantage plans require you to choose your hospital and health care providers from a list of in-network options, while others offer out-of-network coverage. If you currently have a list of doctors that you would like to continue seeing, you’ll want to make sure that your providers participate in the plan’s network. If the plan provides you with a list of acceptable providers, it’s important to determine if those doctors or pharmacies are conveniently located in relation to your home. Additionally, taking the time to call these providers upfront will help you understand if they are accepting new patients, or if they require a referral before a visit is possible. Medicare provides a helpful online tool to assist you in finding and comparing health providers near you that accept Medicare. Through this tool, you can gather an estimate of doctors’ costs in your area and quality ratings for different facilities.

What Is The Plan’s Medicare Rating?

When considering which Medicare Advantage plan to choose, it’s wise to consult Medicare’s Star Rating for insight into each plan’s quality of care. Medicare assigns a 1-5 star quality rating for factors such as customer service, preventative care offered, and the percentage of people that exit the plan annually. Medicare also collects data on member complaints, how well the plan offers assistance for chronic conditions, and the availability of benefits like screenings, tests and vaccines. To use Medicare’s Star Rating tool, visit Medicare.gov to search by your ZIP code and view available plans. Although these ratings do not provide a comprehensive look at the pros and cons of each plan, they are a great starting point in helping you to narrow down the options based on care quality. Evaluating these ratings upfront might prevent you from having to switch plans down the road.

Eldercare Financial Assistance Locator

  • Discover all of your options
  • Search over 400 Programs
Get Started

FAQ

What does Medicare Advantage cover?

Medicare Advantage plans cover just about everything Original Medicare covers, but via private health insurers. Many providers offer plans that combine Parts A and B into a single Part C plan. Others offer Part D prescription coverage and some go beyond Medicare to provide extras such as gym memberships.

Who is eligible for Medicare Advantage?

Any U.S. citizen who qualifies for Medicare can enroll in a Medicare Advantage plan. Some plans are only available in certain states, but all 50 states, the District of Columbia and Puerto Rico have at least some coverage.

How do I find Medicare Advantage plans in my area?

The official Medicare website has plenty of information about Medicare Advantage plans available. Specific companies also often list their plans online. And many offer a plan finder tool that searches for Medicare Advantage plans they offer in your state.

Where can I find more resources on Medicare Advantage?

Medicare.Gov has a plan comparison tool that can help kickstart your research into covered services and the plans available to you.

Top Rated Assisted Living Communities by City

STATE -Select-
CITY -Select-