Comparing Medicare Advantage plans

This post applies to the 54 percent of the Medicare population in Medicare Advantage. I’m not knowledgeable about the Medigap and drug plans that people on traditional Medicare buy.

The email arrived now because it’s Medicare Open Enrollment, an annual period when Medicare Advantage enrollees can change our coverage. Its subject line was “Have you explored the 65 Medicare Advantage plans available in your area?”

Medicare encourages us to review plans during Open Enrollment even if we’re satisfied with our current one. New or revamped plans may offer a better deal. 

How does one choose from dozens of Medicare Advantage plans? Go to Medicare.gov and click on “Find health plans.” Enter the requested information, including medications. People who want to see specialists without a referral should check the PPO box. Either a PPO or an HMO is all right with me because I’d see the same doctors in the Rush network regardless. I eliminated the majority of plans because of deductibles, premiums, mediocre ratings, and high maximum out-of-pocket costs.

Two plans looked the best for me: Humana Gold Plus (4 stars), my current insurer, and Cigna Preferred Medicare (4½ stars), which has a few lower costs. Comparing them was sometimes difficult. Take dental care. For comprehensive procedures, Humana has coinsurance (a percentage of the cost), while Cigna has a copay (a set amount). 

Copays for advanced imaging were also hard to compare. When I saw that Humana was raising its copay for ultrasound, MRI, and CT scans from $20 to $150, I went to its website and Cigna’s for more information. Cigna says, “A facility fee may apply” in addition to a copay. Hospitals are charging facility fees for procedures done at their clinics. A Rush financial counselor wouldn’t say how much a facility fee for the ultrasound I get along with my no-cost mammogram would be. I’m left thinking the increase in Humana’s copay, likely because of facility fees, is excessive, but Cigna’s cost could be more.

The most worrisome initial finding on Medicare.gov applied to all plans. The first time I went into the site, it showed that no insurer was covering my only medication! Is my medication one that insurers are dropping next year because Medicare will cap out-of-pocket drug costs at $2,000? 

A phone call to Humana assured me that the medication would be covered. I also consulted Humana’s online drug formulary, which showed that the drug is available but not in the three-month supply I have been ordering. I went back into Medicare.gov, put in 60 capsules for two months, and was relieved to see that the medication is covered by multiple insurers. 

Because of that confusion, I offer this advice: If the information on Medicare.gov looks questionable, don’t assume you have to bite the bullet and pay more next year. Call the insurer and ask questions. Consult the evidence of coverage and drug formulary documents on insurers’ websites.

You can guess that reviewing the 2025 Medicare Advantage options took a fair amount of time, even aided by my research experience as an editor and journalist. If doing these nitty-gritty comparisons on your own seems overwhelming, you might consult your state’s Senior Health Insurance (SHIP) program. You could also consult insurance agents, but know that they aren’t required to represent all insurers.

I decided to remain with Humana Gold Plus, confident that I’d done a thorough comparison and wasn’t staying just because I’ve been happy with it.

Medicare Open Enrollment continues until December 7.